Asphyxia and Hypoxic-Ischemic Encephalopathy
What is asphyxia?
Asphyxia is when there is less than normal oxygen delivered to the body or an organ and there is build up of carbon dioxide in the body or tissue. Not enough blood flow to an organ can cause asphyxia.
When does asphyxia occur?
It can happen any time--a long time before birth, shortly before birth, during delivery or after birth.
What happens with asphyxia?
If the period of asphyxia is short, the body may recover without damage. If the time is longer there may be injury that is reversible, not permanent. If the period is very long there may be permanent injury to one or more organs of the body.
How does someone know if there is asphyxia?
Before birth, asphyxia may occur without people knowing. If the pregnancy is high risk, the obstetrician may monitor the baby before birth looking for heart rate patterns, activity, and amount of amniotic fluid. If a baby is not doing well in the womb the heart rate pattern may become abnormal and/or the baby may stop moving. After birth, doctors can observe more directly the baby's heart rate, color, breathing and activity. Sick babies often have their heart rate, breathing rate, blood pressure, and oxygen monitored all the time.
How is asphyxia treated?
The goals of treatment are to:
- prevent further asphyxia by trying to make oxygen, carbon dioxide and blood pressure normal
- support the baby so the body can repair the damage that it is possible to repair
Your baby may need:
- medicine for seizures
- medicine to keep blood pressure normal
- to be feed by vein
- to be on a breathing machine
If your baby has seizures, s/he will probably have an EEG - electroencephalogram or brain wave test. In addition, your baby's doctors may choose to do other tests ( Head ultrasound, CT scan or MRI) if they think they are needed.
What is Ischemic-Hypoxic Encephalopathy (IHE)?
Ischemic means not enough blood flow. Hypoxic means too little oxygen. Encephalopathy means abnormal brain function. IHE means that for a peroid of time there was too little oxygen and blood flow to the brain. This causes the brain to act abnormal.
How does a baby with IHE act?
- The baby will have abnormal activity, either very irritable and tense or very low tone and little or no activity
- The baby may have seizures or abnormal movements
- The baby may not breathe normally or have apnea, a period of no breathing
- The baby may show signs of damage to other organs
- Kidney - too little or too much urine, blood in the urine, proteins in the urine, abnormal tests of kidney function (BUN and Creatinine)
- Liver- abnormal tests of liver function
- Blood - difficulty clotting blood
- Intestines - blood in the stool or necrotizing enterocolitis
When will I know if there is permanent brain damage?
Those caring for your baby will be best able to answer this question. Often the answer is known only over time. Babies are most like to have severe problems if they:
- had abnormal EEG's in addition to the seizures on it
- take over two weeks to act like a normal baby or learn to feed normally
- continue to have very low tone
What kinds of long term problems are possible if there is permanent damage?
Serious abnormalities appear gradually. These may include:
Motor (Movement) Problems
- tight or stiff muscles
- holding legs straight and crossed most of the time
- difficulty sitting
- slow to crawl, stand, or walk or inability to do these
- abnormal crawling, toe walking
- frequent arching of the back (not just when angry or at play)
- one side weaker than the other
Slow Mental Development
- does not listen to your voice by age 3-4 months after hospital discharge
- does not make different sounds by 8-9 months after discharge
- doesn't seem to understand or say any words by one year after discharge
Seizures
Poor Hearing or Deafness
Poor Vision
Less serious problems appear more slowly, are more difficult to detect, and may not be obvious until preschool or grade school. These can include:
- poor coordination or balance
- specific learning disabilities (math or reading)
- very short attention span
- behavioral problems
- difficulty with activities that require coordination of the eyes and hands; for example, catching a ball or copying a simple drawing
It is very important for babies who have IHE to receive close follow-up of their development. If your baby has IHE, s/he may be eligible for a developmental intervention program, visit Family Village for further details. Anytime in the future if you are concerned about something that you think might be abnormal, have it checked out by your baby's doctor.
Additional Resources
More information on Asphyxia from Emory Pediatrics
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