Treatments for asphyxia at birth focus on rapidly restoring oxygen supply to the newborn’s tissues, supporting breathing and circulation, and minimizing brain injury caused by oxygen deprivation. The approach involves immediate resuscitation measures followed by specialized supportive care and neuroprotective therapies.
At birth, if a baby shows signs of asphyxia—such as poor breathing effort, low heart rate, or limpness—initial steps include clearing the airway by suctioning the mouth and nose, positioning the head to open the airway, and providing gentle tactile stimulation to encourage breathing. If spontaneous breathing does not start promptly, supplemental oxygen is administered. This may be delivered through a mask or nasal prongs to increase oxygen levels in the blood.
If oxygen alone is insufficient, respiratory support escalates to continuous positive airway pressure (CPAP), which helps keep the lungs inflated and improves oxygen exchange. When CPAP is inadequate, more advanced ventilation methods are used, such as nasal intermittent positive pressure ventilation (NIPPV) or mechanical ventilation via intubation. Mechanical ventilation involves placing a tube into the baby’s windpipe and using a machine to control breathing, ensuring adequate oxygen delivery and removal of carbon dioxide.
In severe cases where conventional ventilation fails to maintain oxygenation, extracorporeal membrane oxygenation (ECMO) may be employed. ECMO is a form of heart-lung bypass that oxygenates the blood outside the body, allowing the lungs and heart to rest and recover.
Alongside respiratory support, circulatory support is critical. If the newborn’s heart rate remains low despite ventilation, medications such as adrenaline (epinephrine) may be administered through an umbilical venous catheter or endotracheal tube to stimulate heart function and improve blood flow.
To reduce brain injury caused by oxygen deprivation, therapeutic hypothermia is a key treatment. This involves carefully cooling the baby’s body or head to around 33 to 35 degrees Celsius for about 72 hours. Cooling slows the brain’s metabolism and reduces the cascade of damaging biochemical events triggered by lack of oxygen. Therapeutic hypothermia must be started within six hours of birth to be effective and is closely monitored to avoid complications. After the cooling period, the baby’s temperature is gradually returned to normal.
Research is ongoing into additional neuroprotective treatments to complement hypothermia. These include medications such as erythropoietin, which may promote brain repair, antioxidants like allopurinol, and other agents that reduce inflammation and oxidative stress. Some experimental therapies involve stem cells or drugs that modulate brain signaling pathways, but these are not yet standard care.
Supportive care in the neonatal intensive care unit (NICU) includes maintaining normal blood sugar and electrolyte levels, preventing infections, and managing seizures if they occur. Seizures are common in babies with severe asphyxia and are treated with anticonvulsant medications.
In summary, the treatment of birth asphyxia is a multi-step process beginning with immediate resuscitation to restore breathing and circulation, followed by advanced respiratory support if needed, neuroprotective cooling therapy, and comprehensive supportive care to optimize recovery and reduce long-term brain damage. Early recognition and rapid intervention are critical to improving outcomes for affected newborns.