Transient Hypoxia in Newborns
What is Transient Hypoxia in Newborns?
Transient means that something only lasts for a short amount of time. Hypoxia is a condition where the body’s tissues do not have enough oxygen. In some cases, newborns who are victims of medical negligence are impacted by transient hypoxia.
For a short amount of time, these newborns may not receive enough oxygen to their brain and other parts of their body. The cells inside the body’s tissues depend on oxygen to produce energy and function properly. Even 30 minutes of oxygen deprivation can lead to brain damage or turn into anoxia.
Prenatal hypoxia is one of the leading causes of long-term brain injury. Hypoxia is defined by oxygen saturation levels in the blood falling below 90%. The primary cause of transient hypoxia in newborns is birth asphyxia.
What is the Difference Between Hypoxia and Ischemia?
Hypoxia is a shortage of oxygen in the blood. Humans initially inhale oxygen through their lungs, which passes through the alveoli (tiny air sacs within the lungs). The oxygen then dissolves into the bloodstream.
The oxygenated blood travels to the heart and is pumped back out to the rest of the body’s tissues. The cells inside the body’s tissues depend on oxygen to produce energy and function properly. Without it, these functions may begin to shut down. This is how hypoxia can lead to brain damage.
Ischemia is a clinical condition in which the blood flow to vital organs gets reduced or restricted. Depending on the organ, the condition may be called cardiac ischemia, kidney ischemia, or brain ischemia.
In babies, when the blood does not adequately flow to the brain in the prenatal or neonatal stage, it is known as infant brain ischemia. Ischemia starves cells and tissues of nutrients and oxygen, which can cause hypoxia.
What is the Difference Between Transient Hypoxia and HIE?
Transient hypoxia can cause brain injuries like hypoxic-ischemic encephalopathy (HIE), which occurs when the baby’s brain is deprived of oxygen. HIE can occur prior to birth, during labor and delivery, or shortly after birth. The length and amount of oxygen deprivation to the brain will determine the severity of brain damage caused by the HIE.
HIE is characterized by both a deficiency in oxygen in the blood and a lack of blood flow to the brain. In contrast, transient hypoxia is a temporary form of oxygen deprivation in the blood. Episodes of transient hypoxia may recur, while HIE is typically one event of prolonged oxygenated blood deprivation to the brain.
Babies with a truly mild form of hypoxic ischemic encephalopathy may not suffer any long-term effects. Babies with moderate to severe HIE may eventually suffer from cerebral palsy, developmental delays, cognitive impairments, and/or epilepsy. Early signs of HIE can include abnormal muscle tone, poor reflexes, lack of alertness, breathing difficulties, feeding problems, low APGAR scores, and/or seizures.
What Causes Transient Hypoxia?
When a blockage obstructs oxygen and blood from flowing to the baby’s brain, this is called birth asphyxia. This is the leading cause of transient hypoxia during labor and delivery. Premature babies are more susceptible to hypoxia due to their increased risk of breathing problems.
Several complications can cause birth asphyxia during the mother’s pregnancy or later during childbirth. Typically, complications with the umbilical cord or the placenta causes the asphyxia that results in hypoxia. Other complications include that cause transient hypoxia include:
Prolonged and Arrested Labor
Doctors will typically call a mother’s labor “prolonged” when it lasts past 18-20 hours. An arrested labor is one that ceases to progress at all.
Many complications can cause prolonged or arrested labor. Fetal size abnormalities like macrosomia or cephalopelvic disproportion can complicate the baby’s exit out through the birth canal. Other irregularities, such as weak contractions or abnormal fetal positioning in the womb, can prolong the labor process.
A baby has weaker access to oxygen after the mother’s water breaks and labor begins. The longer labor lasts, the greater the baby’s risk is for asphyxia and subsequent hypoxia.
Uterine Hyperstimulation
Uterine hyperstimulation is a complication where the mother’s uterus contracts too frequently and/or forcefully during labor. It can either occur naturally or as a side effect from labor-inducing medications like Pitocin and Cytotec.
Just like with a prolonged labor, excessive uterine contractions can restrict the baby’s access to oxygen and blood flow. Going too long without oxygenated blood can result in severe hypoxic and ischemic (lack of blood flow) brain injuries.
About Uterine Hyperstimulation
Placental Complications
The placenta plays a critical role in fetal gas exchange. It absorbs oxygen from the mother’s blood and transfers oxygenated blood and nutrients to the baby through the umbilical cord.
A damaged placenta can disturb this process. Placental complications like a placental abruption or uteroplacental insufficiency can leave the baby with diminished levels of oxygen. Prolonged periods with low oxygen can result in hypoxia, tissue damage, and brain damage at birth.
Umbilical Cord Problems
The baby receives all its oxygen and nutrients through the umbilical cord. The cord is also the baby’s route for discarding carbon dioxide and other waste products.
Umbilical cord complications like compression or a nuchal cord can prevent sufficient levels of oxygen from reaching the fetus. If a baby goes too long without a functioning umbilical cord, the resulting oxygen deprivation can cause hypoxia and anoxia.
Even before delivery, a baby can suffer from birth asphyxia while still in the womb. It is very important that doctors and nurses recognize and respond to the signs of birth asphyxia during labor and delivery to prevent transient hypoxia.
Fetal heart rate monitoring can reveal low heart rates and decreased fetal movement, which are signs that the baby is in fetal distress. Fetal distress is often caused by oxygen deprivation.
When doctors observe a baby in fetal distress and suspect birth asphyxia or hypoxia, it is a medical emergency that requires an immediate delivery to restore oxygen.
What are the Signs & Symptoms of Transient Hypoxia?
A baby suffering from transient hypoxia may show signs of oxygen deprivation even before they are born. Doctors, obstetricians, nurses, and other medical professionals must identify these signs and address them to prevent birth asphyxia.
Some of the common symptoms of transient hypoxia both after birth include:
- Fatigue or lethargy (low movement)
- Weak or poor muscle tone
- Yellowish color (Jaundice)
- Absence of crying or weak crying
- Absence of urination
- Poor reflexes
- Low blood pressure
Other signs that your baby is suffering from transient hypoxia during pregnancy, labor, or after birth include:
Fetal Distress
One of the earliest indications of oxygen deprivation in utero is changes in fetal heart rate. A non-reassuring fetal heart rate almost always means that the fetus is not receiving enough oxygen.
It is natural for a temporary restriction of oxygenated blood to occur as the mother contracts during labor. However, a baby can only go so long without sufficient oxygen before they go into birth asphyxia and their heart rate drops.
Doctors and healthcare providers should constantly monitor fetal heart rate during labor and delivery to identify fetal distress. Failure to address the signs of a non-reassuring fetal status during pregnancy and labor constitutes medical malpractice.
Low APGAR Scores
The APGAR test is a routine, standardized assessment of a newborn’s physical qualities immediately upon delivery. Medical professionals award 0-2 “points” while evaluating the baby’s Appearance, Pulse, Grimace, Activity, and Respiration.
A baby who has suffered from hypoxia will likely score low for all categories, especially for Respiration and Pulse. Severe oxygen deprivation may cause a blue appearance to the skin, especially in the lips, hands, and feet. But it’s important to note that medical bias and subjectivity can interfere with the APGAR score’s reliability.
Neonatal resuscitation often begins immediately after birth and before the one-minute APGAR score. An improvement between the one-minute and five-minute scores can indicate the newborn is responding well to treatment.
Respiratory Distress Syndrome (RDS)
Babies with underdeveloped lungs can go into respiratory distress upon birth. Symptoms can include rapid and shallow breathing, flared nostrils, and a blueish hue around the baby’s lips, fingers, and toes.
Babies suffering from oxygen deprivation will likely meet the criteria for respiratory distress syndrome at birth. This is a sign that they will require assisted ventilation or even possibly neonatal resuscitation.
Respiratory distress syndrome is especially prominent in premature babies, specifically babies born before 28 weeks of gestation. Medical interventions, such as oxygenation and ventilation are usually required.
When the risk of premature birth is high, the medical providers should consider corticosteroids administration as a preventative measure to the expectant mother between 24 and 34 weeks of gestation. The medical team should also be prepared to provide timely neonatal resuscitation according to the updated guidelines for babies born with RDS.
Fetal Acidemia
Babies who suffer from oxygen deprivation may have an excess amount of carbon dioxide in their blood as a result. Because carbon dioxide is acidic, too high of a concentration can throw off the baby’s blood pH balance.
When doctors fail to respond to birth asphyxia fast enough, fetal acidosis can occur and result in severe long-term consequences. This includes transient hypoxia, hypoxic-ischemic encephalopathy (HIE), cerebral palsy, or even fetal death.
Doctors take umbilical cord blood samples just after delivery to determine pH levels in the baby’s blood and tissue. These results can help doctors determine whether a baby has suffered from hypoxia during the delivery process.
Meconium Aspiration Syndrome (MAS)
Meconium aspiration syndrome increases the baby’s risk for asphyxia, transient hypoxia, and respiratory distress. Meconium is the baby’s first stool. It typically lines the baby’s intestines but can sometimes mix in with the amniotic fluid in the womb.
MAS is a major cause of serious medical complications or death in infants, usually occurring during prolonged or arrested labor or when the baby is born prematurely.
If a baby is already in fetal distress, a sudden gasp of air could cause them to inhale meconium-stained fluid. This can be dangerous if the meconium enters the baby’s lungs and blocks their airways.
Neonatal Seizures
Neonatal seizures are often a sign that the baby suffered fetal distress or birth trauma during the labor and delivery process or shortly after birth. When the brain fails to receive oxygen, seizures may occur as the brain begins to malfunction.
When newborn seizures occur while the baby is still in the hospital shortly after birth, the medical providers must act quickly to control the seizures which can cause further brain damage due to oxygen deprivation (hypoxia/anoxia).
What Factors Increase the Risk of Transient Hypoxia?
Although transient hypoxia is marked by a shorter interval of oxygen deprivation, it may be a recurring issue. A premature baby in the NICU, for example, may suffer over 300 brief episodes of hypoxia. Even these short episodes of hypoxia can cause permanent brain damage.
Mismanaging birth complications after delivery can increase the baby’s risk of hypoxia. Errors during resuscitation or other forms of neonatal breathing mismanagement can lead to brain damage at birth. Labor and delivery complications that increase the risk of transient hypoxia include:
Premature Birth
Premature birth can increase a baby’s risk of having an underdeveloped respiratory system. Their underdeveloped lungs can cause respiratory distress and pauses in breathing (apnea), both of which impact their oxygen supply.
A shortage of oxygen can increase the premature baby’s risk for hypoxia at birth.
Shoulder Dystocia
Shoulder dystocia is a complication where the baby’s head delivers but their shoulders remain lodged behind the mother’s pubic bone.
Shoulder dystocia can cut off blood circulation to the baby’s head. It can also increase the risk for umbilical cord compression during labor. Both issues can restrict the flow of oxygen-rich blood to the baby and result in hypoxia.
Labor-Inducing Medications
Labor-inducing medications like Pitocin and Cytotec can sometimes cause contractions that are too frequent and forceful. Complications like uterine hyperstimulation and tachysystole can cut off the baby’s access to oxygen beyond the point of safety.
About Labor-Inducing Medications
Forceps and Vacuum Extraction Errors
During a prolonged or arrested labor, doctors may decide to assist delivery using instruments like forceps and vacuum extractors.
Using excessive force with these tools can cause birth-related head injuries such as intracranial hemorrhages or brachial plexus injuries. The bleeding and swelling from these injuries can impair blood flow and cause oxygen deprivation, leading to neonatal brain injuries.
Pregnancy Complications
A risk factor for transient hypoxia is any birth complication that could indirectly pose a threat to the baby’s oxygen supply. These complications increase the risk of blockages that cause birth asphyxia and ultimately lead to hypoxic brain injuries.
Some pregnancy complications can result in fetal oxygen deficiency that causes transient hypoxia, including:
Oligohydramnios
Oligohydramnios is a complication where the mother has lower levels of amniotic fluid in the womb. Amniotic fluid promotes fetal organ development and provides cushioning and protection to the baby.
Amniotic fluid allows the baby to move around and reposition in the womb. It also protects them from pushing against their umbilical cord and squeezing it into the uterine wall.
Oligohydramnios can increase the risk of umbilical cord compression, which restricts oxygenated blood flow. Prolonged cord compression can lead to fetal asphyxia and transient hypoxia before birth.
Intrauterine Growth Restriction
Intrauterine growth restriction (IUGR) occurs when the mother’s dysfunctional placenta fails to deliver sufficient nutrients to the baby. Placental insufficiency can lead to low birth weights, birth defects, and reduced oxygenation.
The reduced oxygen transfer can contribute to the baby’s risk of fetal distress and prolonged hypoxia.
Maternal Infections
Common maternal infections like Group B Strep can increase a baby’s risk for oxygen deprivation. Untreated infections while the baby is in utero can develop into neonatal infections either upon birth or through placental transfer.
When a baby catches an infection, they can experience inflammation that can cause lung damage and impair fetal gas exchange. This increases their risk for oxygen deprivation and fetal distress.
Anemia in Infants
After passing through the lungs, oxygen binds to the hemoglobin protein in red blood cells. Anemia is a blood condition where the body produces fewer healthy red blood cells.
Having fewer red blood cells decreases the blood’s oxygen-carrying capacity, leading to reduced oxygenation. Anemia can occur while the baby is still in the womb, increasing their risk for fetal transient hypoxia.
Blood Clots During Pregnancy
A mother’s blood clots during pregnancy can be extremely dangerous for both her and her baby. Any clots or parts of a clot (embolus) that travel to the mother’s lungs can severely block her airways. This blockage can prevent proper blood circulation to her placenta and impair fetal gas exchange.
In rare cases, blood clots can also appear in the placental blood vessels. This can directly block blood flow to the baby (known as ischemia) and cause an oxygen deficiency.
About Blood Clots During Pregnancy
High-Risk Pregnancy
Certain pregnancy complications or having multiple complications at once can classify a mother’s pregnancy as “high risk”.
Conditions like maternal obesity, gestational diabetes, and preeclampsia can all contribute to a baby’s oxygen deprivation in utero.
It is crucial that medical professionals properly diagnose and manage these conditions. Failure to do so can cause permanent brain injury like hypoxic-ischemic encephalopathy or cerebral palsy. Errors or failure in identifying and addressing fetal distress constitutes medical malpractice.
What are the Complications of Transient Hypoxia?
Prenatal hypoxia is one of the leading causes of lifelong brain injury. Brain damage can result in a disruption or impairment to a newborn’s natural cognitive functions and cause developmental delays.
Some infants recover from transient hypoxia without any complications. Some are left with lifelong disabilities and brain damage.
The difference between these two outcomes depends on the completeness and severity of oxygen loss. The timeliness in treating neonatal transient hypoxia is of utmost importance to prevent permanent brain damage.
Mismanagement of transient hypoxia can manifest into hypoxic-ischemic encephalopathy (HIE). The brain damage caused at birth can turn into cerebral palsy, leaving the child with lifelong disability and family with lifelong medical expenses.
Preterm babies are at a higher risk of developing complications from transient hypoxia. One study suggests that even one brief episode of hypoxia can significantly disrupt the maturation of the hippocampus.
The hippocampus is the part of the brain that is responsible for learning and memory. In short, transient hypoxia can not only cause complete cell death, but it can also cause cell growth impairment.
How is Transient Hypoxia Treated After Birth?
If an infant has mild asphyxia at the time of birth, the medical team should perform initial stabilization maneuvers. These can include head repositioning, tactile stimulation, and nose and mouth suctioning.
Doctors must intervene further when the baby suffered a more severe hypoxic or anoxic brain injury. The proper neonatal resuscitation methods include:
- Supplemental oxygen
- CPAP – continuous positive airway pressure
- NIPPV – noninvasive positive pressure ventilation
- Intubation Mechanical ventilation or bag & mask ventilation
Medical providers should order a full cardiac evaluation to rule out any congenital cardiopulmonary defects. At the same time, more advanced treatments or treatment combinations that doctors may consider implementing includes:
High Frequency Oscillatory Ventilation (HFOV)
This ventilatory technique provides breathing support to the infant from a machine that uses pressure oscillations to deliver low volume but rapid puffs of air into the baby’s lungs. The mechanism is gentler than a standard breathing machine to ensure that the delicate lungs of the newborn do not suffer any damage from high airway pressure.
Inhaled Nitric Oxide
If the newborn has pulmonary hypertension (high blood pressure in the lungs), doctors may use inhaled nitric oxide. The infant will receive the gas into their airway through a heart-lung pump or a breathing tube for life support. This will enable dilation (opening) of the blood vessels in their lungs so they can take in more oxygen.
Therapeutic Hypothermia (Brain Cooling)
Therapeutic hypothermia can help protect the infants who have suffered HIE injury from further damage. Medical providers should ideally start this treatment within six hours after birth to minimize brain damage.
The therapy involves cooling the infant’s internal body temperature to about 91°F for a period of 72 hours. Doctors should only apply brain cooling when the infant’s gestational age is 35 weeks or more. Administering this treatment to premature babies can risk further injury.
What is the Prognosis of a Newborn with Transient Hypoxia?
The outlook for transient hypoxia depends on how severe the oxygen deprivation is, how often it occurred, and how much brain damage resulted. If a newborn is treated promptly and properly, medical providers may be able to limit brain damage.
Newborns with severe brain injury from transient hypoxia may have developmental delays, cognitive impairments, and physical restrictions. In extreme cases, the brain damage can result in cerebral palsy, which is a group of non-progressive physical and neurological disorders.
How Does Oxygen Deprivation Damage the Brain?
Hypoxia that affects the brain is called cerebral hypoxia. Generally, one minute of oxygen deprivation will cause brain cell death. However, the completeness and severity of the oxygen deprivation will dictate the subsequent brain injuries, if any.
Oxygen deprivation of the brain can manifest through several physical symptoms, such as poor muscle tone, seizures, and discoloration of extremities. Depending on the severity of the hypoxia, or if it manifests into a complete loss of oxygen (anoxia), the brain’s functions may be permanently impacted.
The totality of brain damage may not be apparent until your baby starts to miss developmental milestones. The four main categories of developmental milestones are:
- Movement/Physical Development
- Social/Emotional Domain
- Language/Communication
- Cognitive Functioning
Additionally, some milestone domains can break into smaller subcategories. Developmental specialists will want to closely monitor a child’s hearing, speech, vision, and physical milestones alongside the other categories.
Hearing Development Delays
Hearing developmental milestones track how babies and children respond to sounds, voices, language, and communication cues as they grow up.
Strong hearing skills are crucial to speech development, learning, and building strong social and emotional bonds.
Speech Development Delays
Developmental speech milestones focus on how children learn to communicate through sounds, words, gestures, and sentences.
Speech development relies primarily on healthy brain function, muscle coordination, and hearing. Babies with brain damage or other birth injuries may have a higher risk for speech impairments and delayed speech milestones.
Physical Development Delays
Physical developmental milestones measure how children build muscle strength, coordination, balance, and movement skills.
Birth injuries to the brain or spinal cord injuries can sometimes disrupt neuromuscular control and cause conditions like cerebral palsy. Children with these injuries will likely experience at least some degree of impaired gross motor function.
Visual Development Delays
Visual developmental milestones evaluate children’s ability to focus, track and recognize objects, process visual input, and coordinate vision with movement. Strong vision can support learning, communication, social development, balance, and coordination.
Birth injuries can sometimes damage a child’s visual processing centers and lead to vision impairments. Common problems that cause developmental delays include cortical visual impairment (CVI) or retinopathy of prematurity (ROP).
Did Medical Errors Cause My Child’s Hypoxia at Birth?
Transient Hypoxia can cause brain injuries like HIE and other neurological outcomes that will forever alter a child’s life. Birth injury negligence, like delaying a C-section amid fetal distress or delaying therapeutic hypothermia after birth, increases the baby’s risk.
If a family believes medical negligence worsened a child’s brain damage at birth, 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 birth injuries from transient hypoxia want and deserve answers as to the cause of their child’s birth injury and whether mistakes by the doctors and nurses contributed to the injury.
- Did the medical team fail to detect signs of fetal distress that indicate oxygen deprivation?
- Was treatment improperly administered or delayed?
- Did the medical team fail to stop premature birth?
- Were there signs of pregnancy complications affecting oxygen levels that were not addressed?
Families who have experienced the effects of hypoxic brain injuries from negligent medical care deserve to know whether they were avoidable. Our top rated birth injury lawyers will help you find those answers and obtain the necessary funds to secure treatment.
Our National Birth Injury team will thoroughly investigate the facts, holding responsible parties accountable by pursuing medical malpractice claims.
What is the Statute of Limitations in a Birth Injury Lawsuit?
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 case and the state where you file. For instance, the deadline for birth injury claims is typically different from other claims, such as injury to private property.
Generally, the clock starts ticking on the date the injury occurred. However, there are exceptions to this rule. 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
Birth Injury Claim Under Federal Tort Claims Act (FTCA)
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, you may have less time to give notice if:
- The negligent party was a local or state government hospital.
- The doctors and medical providers are employees of a governmental entity.
If you file your case outside of the statute of limitations, the court will typically dismiss it. This means you will not be eligible to recover compensation for you or your child’s injuries.
Determining when a statute of limitations begins on your case can be tricky. If you are considering pursuing compensation, contact a birth injury attorney as soon as possible.
How Can Our Birth Injury Attorneys Help?
Doctors can sometimes prevent fetal transient hypoxia by taking quick action in response to non-reassuring fetal heart rates. However, it takes an expert review of the facts of your birth to determine whether medical professionals made preventable errors.
Our Process
Our team of committed attorneys, nurses and paraprofessionals work to answer these questions and seek compensation. We use our detailed medical negligence case review process to assess your potential birth injury case.
We start by learning more about your pregnancy by gathering records to determine what happened during and after your delivery. This includes evaluating the fetal heart rate strips during labor and umbilical cord arterial blood gas testing procedures after birth.
We will call in skilled medical experts who review your records and provide insight into where medical professionals went wrong. If we feel medical negligence caused or worsened your baby’s hypoxia, we meet with you to discuss further.
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 once you do. The sooner you reach out, the sooner we can investigate your case and gather the evidence to support your claim.
We work on a contingency fee basis, meaning you will not pay any legal fees until we win your case. We do not purse any medical malpractice cases unless we fully believe we can win.
Contact us today to schedule your free consultation by calling our toll-free line at (888) 987-0005. You can also reach us by filling out our online request form.
National Birth Injury Law
Our National Birth Injury Attorneys, nurses, and support staff understand that parents of children with birth injuries feel overwhelmed. So, every client has the attention and support of a team of trained, compassionate professionals. But we don’t just offer compassion.
We offer a process to help you discover whether your child’s birth injury, HIE, cerebral palsy or brain injury at birth was caused by medical malpractice.
Call our offices today at (888) 987-0005 for experienced assistance in a free consultation.
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