Asphyxia neonatorum is respiratory failure in the newborn, a condition
caused by the inadequate intake of oxygen before, during, or just after
Asphyxia neonatorum, also called birth or newborn asphyxia, is defined as
a failure to start regular respiration within a minute of birth. Asphyxia
neonatorum is a neonatal emergency as it may lead to hypoxia (lowering of
oxygen supply to the brain and tissues) and possible brain damage or death
if not correctly managed. Newborn infants normally start to breathe
without assistance and usually cry after delivery. By one minute after
birth most infants are breathing well. If an infant fails to establish
sustained respiration after birth, the infant is diagnosed with asphyxia
neonatorum. Normal infants have good muscle tone at birth and move their
arms and legs actively, while asphyxia neonatorum infants are completely
limp and do not move at all. If not correctly managed, asphyxia neonatorum
will lead to hypoxia and possible brain damage or death.
According to the National Center for Health Statistics (NCHS), in 2002,
caused by asphyxia neonatorum amounted to 14.4 deaths per 100,000 live
births in the United States, representing the tenth leading cause of
infant mortality. Worldwide, more than 1 million babies die annually from
complications of birth asphyxia. According to the World Health
Organization, asphyxia neonatorum is one of the leading causes of newborn
deaths in developing countries, in which 4 to 9 million cases of newborn
asphyxia occur each year, accounting for about 20 percent of the infant
Causes and symptoms
There are many causes of asphyxia neonatorum, the most common of which
include the following: prenatal hypoxia (a condition resulting from a
reduction of the oxygen supply to tissue below physiological levels
despite adequate perfusion of the tissue by blood), umbilical cord
, occurrence of a preterm or difficult delivery, and maternal anesthesia
(both the intravenous drugs and the anesthetic gases cross the placenta
and may sedate the fetus). High-risk pregnancies for asphyxia neonatorum
The symptoms of asphyxia neonatorum are bluish or gray skin color
(cyanosis), slow heartbeat (bradycardia), stiff or limp limbs (
), and a poor response to stimulation.
Pregnant women who are at high risk of delivering newborns with asphyxia
neonatorum should arrange for a close follow-up of their pregnancy with
Diagnosis can be objectively assessed using the Apgar score—a
recording of the physical health of a newborn infant, determined after
examination of the adequacy of respiration, heart action, muscle tone,
skin color, and reflexes. Normally, the Apgar score is of 7 to 10. Infants
with a score between 4 and 6 have moderate depression of their vital signs
while infants with a score of 0 to 3 have severely depressed vital signs
and are at great risk of dying unless actively resuscitated.
The treatment for asphyxia neonatorum is resuscitation of the newborn. All
medical delivery rooms have adequate resuscitation equipment should an
infant not breathe well at delivery. Between 1970 and 2000, neonatal
resuscitation has evolved from disparate teaching methods to organized
programs. The most widely used procedure is the Neonatal Resucitation
Program, supported by the American Academy of Pediatrics (AAP) and the
American Heart Association (AHA).
If stimulation fails to initiate regular respiration in the newborn, the
attending physician attempts resuscitation. He may decide first to gently
suction the oropharynx—the area of the throat at the back of the
mouth, with a soft catheter. When stimulation and a clear airway do not
result in adequate respiration, the physician may give 100 percent oxygen
via a face mask. If the infant is still not breathing, some form of
artificial ventilation is then required. The usual method is to use mask
ventilation with a resuscitator. The mask is applied tightly to the
infant's face. If this procedure fails, the infant can be intubated
with a endotracheal tube to which the resuscitator can then be connected.
The more severe the fetal asphyxia, the longer it will take before the
infant starts to breathe spontaneously. If the infant does not breathe
despite adequate ventilation, or if the heart rate remains below 80 beats
per minute, the physician can give an external cardiac massage using two
fingers to depress the lower sternum at approximately 100 times a minute
while continuing with respiratory assistance. Adrenaline may also be
administered to increase cardiac output. Once the infant starts breathing,
he or she is transferred to a nursery for observation and further
assessment. Temperature, pulse and respiratory rate, color, and activity
are recorded, and blood glucose levels checked for at least four hours.
Treatment may also include the following:
ECMO is a technique similar to a heart-lung bypass machine, which assists
the infant's heart and lung functions with use of an external pump
If an inadequate supply of oxygen from the placenta is detected during
labor, the infant is at high risk for asphyxia, and an emergency delivery
may be attempted either using forceps or by cesarean section.
The prognosis for asphyxia neonatorum depends on how long the new born is
unable to breathe. For example, clinical studies show that the outcome of
babies with low five-minute Apgar scores is significantly better than
those with the same scores at 10 minutes. With prolonged asphyxia, brain,
heart, kidney, and lung damage can result and also death, if the
asphyxiation lasts longer than 10 minutes.
—Another name for epinephrine, the hormone released by the
adrenal glands in response to stress. It is the principal blood-pressure
raising hormone and a bronchial and intestinal smooth muscles relaxant.
—A condition in which there is an abnormally low number of red
blood cells in the bloodstream. It may be due to loss of blood, an
increase in red blood cell destruction, or a decrease in red blood cell
production. Major symptoms are paleness, shortness of breath, unusually
fast or strong heart beats, and tiredness.
—Treatment with medicine that causes a loss of feeling,
especially pain. Local anesthesia numbs only part of the body; general
anesthesia causes loss of consciousness.
—The results of an evaluation of a newborn's physical
status, including heart rate, respiratory effort, muscle tone, response
to stimulation, and color of skin.
—Lack of oxygen.
—Respiratory failure in the newborn.
—A slow heart rate, usually under 60 beats per minute.
—A bluish tinge to the skin that can occur when the blood oxygen
level drops too low.
—An iron-containing pigment of red blood cells composed of four
amino acid chains (alpha, beta, gamma, delta) that delivers oxygen from
the lungs to the cells of the body and carries carbon dioxide from the
cells to the lungs.
—Having reduced or diminished muscle tone or strength.
—A condition characterized by insufficient oxygen in the cells of
—Refers to the first 28 days of an infant's life.
—One of the three regions of the pharynx, the oropharynx is the
region behind the mouth.
—Inability to rid the body of CO
or establish an adequate blood oxygen level.
—Bringing a person back to life or consciousness after he or she
was apparently dead.
Women at risk for asphyxia neonatorum pregnancies should receive focused
prenatal care from an obstetrician skilled at preventing and detecting
problems such as anemia that may contribute to asphyxia neonatorum. While
prenatal care will not necessarily prevent newborn asphyxia, it can help
ensure that both the mother and her baby are as healthy as possible at the
time of birth.
Birth Asphyxia and the Brain: Basic Science and Clinical Implications.
Edited by Steven M. Donn et al. Malden, MA: Futura Publishing Co., 2002.
Cheung, P. Y., and C. M. Robertson. "Predicting the outcome of term
neonates with intrapartum asphyxia."
89, no. 3 (March 2000): 262–264.
Clark, R., and J. A. Carcillo. "Is it time to revisit a role for
antithrombotic therapy in asphyxia neonatorum?"
Pediatric Critical Care Medicine
5, no. 2 (March 2004): 198–199.
Wiswell, T. E. "Neonatal resuscitation."
48, no. 3 (March 2003): 288–294.
American Academy of Pediatrics (AAP).
141 Northwest Point Blvd., Elk Grove Village, IL, 60007. Web site:
Dave Woods. "Neonatal resuscitation."
International Association for Maternal and Neonatal Health.
Available online at
> (accessed October 11, 2004).