Newborn Resuscitation

During pregnancy the baby is dependent on the umbilical cord and placenta for oxygen delivery. 10% of newborns require some form of assistance to start breathing on their own and 1% requires extensive medical intervention known as neonatal resuscitation.

Neonatal resuscitation refers to emergency intervention techniques employed immediately after childbirth to assist babies who are not able to breathe independently after birth. If a newborn cannot begin breathing independently right away they are at risk of birth asphyxia which can cause serious brain injury and even death.

When abnormal breathing is observed after delivery, doctors (neonatologists/pediatricians) and neonatal nurses will have a very short window of time to intervene to avoid harm to the baby. Anticipating the potential need for neonatal resuscitation is often critical. The leading risk factor for newborn respiratory problems is prematurity. Another common cause of the need for neonatal resuscitation is birth injury from inadequate oxygen to the unborn baby during the labor and delivery process.

Risk factors and Symptoms of Neonatal Resuscitation:

• Maternal hypertension or cardiovascular disease
• Multiples (twins)
• Maternal drug/alcohol usage
• Trauma during birth
• Maternal age over 40
• Fetal macrosomia
• Meconium stained amniotic fluid
• Maternal infection
• Placental abruption

Neonatal Guidelines
Anticipation and Preparation: Newborn resuscitation depends heavily on proper planning and readiness of the team. Effective team behaviors, such as anticipation, communication, briefing, equipment checks, and assignment of roles, result in improved team performance and neonatal outcome.

The obstetrician or maternal fetal medicine doctors and the labor and delivery nurses are required to arrange a team to be present if there are signs that neonatal breathing assistance or neonatal resuscitation may be required. The hospital should then respond by sending a team to the delivery room.

This team may consist of neonatal nurses and/or doctors that will be either a neonatologist or pediatrician, depending upon the size and sophistication of the hospital. If a neonatal team is not requested, or is not assembled prior to delivery, then valuable minutes may be lost while the baby is not breathing.

Even if a team is not present at the time of delivery, the labor and delivery nurses and obstetrician delivering the baby must urgently call a team if a baby is unexpectantly born without breathing or not breathing properly. Every minute counts when a baby is not breathing!

Positive-pressure ventilation and Oxygen therapy (PPV): PPV remains the primary method for providing support for newborns that are apneic, bradycardic, or demonstrate inadequate respiratory effort. Pulse oximetry is used to guide oxygen therapy and meet oxygen saturation goals. This can include the intubation of the baby. A timely intubation will save a baby that is not breathing from any further damage. With proper oxygen therapy, a rise in heart rate is the most important indicator of effective ventilation and response to resuscitative interventions.

Chest compressions: If the heart rate remains less than 60/min despite 30 seconds of adequate PPV, chest compressions should be provided. The suggested ratio is 3 chest compressions synchronized to 1 inflation (with 30 inflations per minute and 90 compressions per minute) using the 2 thumb–encircling hands technique for chest compressions.

Vascular access: When vascular access is required in the newly born, the umbilical venous route is preferred. When intravenous access is not feasible, the intraosseous route may be considered.

Medications: If the response to chest compressions is poor, it may be reasonable to provide epinephrine, preferably via the intravenous route. This can help restart a baby’s heart and must be done timely!

Volume expansion: Failure to respond to epinephrine in a newborn with history or examination consistent with blood loss may require volume expansion.

Knowing the limitations: Doctors and nurses who provide neonatal resuscitation are faced with many challenges with respect to the knowledge, skills, and behaviors needed to perform effectively. These medical providers must be adequately trained on neonatal resuscitation methods and interventions. Neonatal resuscitation will always benefit from ongoing booster training, briefing, and debriefing.

Slow or improper performance of these procedures, and failure to perform procedures when indicated, can critically deprive adequate oxygen and blood flow to the baby. There are very specific guidelines published for medical professionals regarding what should be done in situations requiring neonatal resuscitation. Failure to follow acceptable standards and guidelines relating to neonatal resuscitation is medical negligence or medical malpractice.

Deprivation of oxygen and blood can lead to disability and permanent brain injuries, including hypoxic-ischemic encephalopathy (HIE), cerebral palsy, periventricular leukomalacia (PVL), and brain bleeds. The type and severity of the brain damage depend on many factors, including how long the baby was deprived of adequate blood flow and oxygen.

The Texas Birth Injury Attorneys at Miller Weisbrod understand the significant impact a birth injury will have not only on your child's life, but also your own. As experienced Birth Injury Lawyers, we fight hard for answers and justice if a delivery room error or doctor's negligence caused your child's birth injury.

If your child suffered a serious injury or lifetime disability due to a mistake before, during or after delivery, a lawsuit may be the best way to find out once and for all what happened and who should be held responsible. Contact us today to schedule a free consultation with an experienced birth injury lawyer. We encourage you to call our offices today at 214.987.0005 or toll free at 888.987.0005. You may also contact us by filling out the form on this page for answers to your important questions or to schedule an appointment.

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Signs and Symptoms of Fetal Distress

Fetal distress refers to signs before and during childbirth indicating that the fetus is not well. Fetus is the medical term for a baby prior to delivery. Fetal distress is a complication of labor. It occurs when the baby has not been receiving enough oxygen (birth asphyxia).

The baby reacts at the onset of asphyxia with a series of responses, a regulated redistribution of blood flow that serves to limit the effects of oxygen limitation in vital organs. This enables the baby to survive asphyxia intact unless the insult is profound or prolonged. Each of these stresses produces characteristic fetal heart rate patterns: late decelerations, variable decelerations, or prolonged bradycardia.

Common Conditions
The main sign doctors and nurses look for to determine fetal distress is a non-reassuring heart rate on the fetal monitoring strips. There are a number of conditions that can occur during labor and delivery that may lead to the fetal heart rate to become non-reassuring.

• Anemia (most prevalent obstetric condition seen behind non-reassuring fetal status)
• Oligohydramnios (a condition in which there is a lower level of amniotic fluid around the baby)
• Pregnancy Induced Hypertension (PIH)
• Post-term pregnancies (42 weeks or more)
• Intrauterine Growth Restriction (IUGR)
• Meconium-stained amniotic fluid (a condition in which meconium, a baby’s first stool, is present in the amniotic fluid which can block baby’s airways)

Common Signs of Fetal Distress
Decreased Fetal Movement in the Womb
Movement within the womb is an important indicator of the baby’s health. Some regular pauses in movement are normal because babies sleep in the womb. If the baby becomes less active or ceases to move, this may be a cause for concern.

Abnormal Fetal Heart Rate
To observe an unborn baby’s heart rate, labor and delivery nurses and obstetricians can use either an external or internal fetal monitoring device. External monitoring is done through a belt-like device that can be strapped around a mother’s abdomen, while internal monitoring involves attaching an electrode to the baby’s scalp. Internal monitoring provides the most accurate monitoring.

During the actual labor process, the important document the nurses and doctors must watch are fetal monitoring strips (these are the print outs from the monitor). These strips will have some of the earliest and most telling signs of the potential for fetal distress. Nurses and doctors during the labor and delivery process look for certain heart rate patterns that are recognized signs of fetal distress.
Some fetal heart rate patterns are known indicators of fetal distress. These are called non-reassuring heart rate patterns. The following fetal heart rate patterns are examples of nonreassuring patterns and warrant further investigation and medical intervention:

• An abnormally fast heart rate (tachycardia)
• An abnormally slow heart rate (bradycardia)
• Abrupt decreases in heart rate (variable decelerations)
• Late returns to the baseline heart rate after a contraction (late decelerations)

Abnormal Amniotic Fluid Level
The amount of amniotic fluid can be determined using a variety of ultrasound methods, including a qualitative assessment, the single deepest pocket (SDP), and the amniotic fluid index (AFI). The qualitative assessment is fairly subjective. The ultrasonographer scans the uterus and reports whether the amniotic fluid volume appears to be low, normal, or high, based on their own experience.

If there is abnormally low amniotic fluid, this is a condition called oligohydramnios, which can lead to oxygen deprivation and birth injuries like Hypoxic Ischemic Encephalopathy (HIE) and cerebral palsy (CP).

Abnormal Results of Biophysical Profile (BPP)
A baby’s biophysical profile (BPP) is also often taken if the results of a Nonstress Test (NST) are nonreassuring. In addition to the NST results, the BPP includes an ultrasound to assess fetal movement, breathing, tone, and amniotic fluid volume.

Vaginal Bleeding
Vaginal bleeding is common during pregnancy. Bleeding can also be an indication that something is wrong with the pregnancy. One particularly dangerous example is placental abruption, which occurs when the placenta tears away from the womb. This causes the baby to be deprived of oxygen.

A placental abruption and other placental problems that cause bleeding require very close monitoring, and in many cases, the mother should be admitted to the hospital and given an emergency C-section.

Cramping
Cramping is normal during pregnancy. As the baby grows, the uterus needs to expand. In some cases cramping is an indication of something more serious, such as miscarriage, placental abruption, preeclampsia, a urinary tract infection, or preterm labor.

Maternal High Blood Pressure (Preeclampsia)
Preeclampsia happens when a woman who previously had normal blood pressure suddenly develops high blood pressure* and protein in her urine or other problems after 20 weeks of pregnancy. Women who have chronic hypertension can also get preeclampsia.

Insufficient or Excessive Maternal Weight Gain
Experts believe that for women with a healthy pre-pregnancy weight, a weight gain of anywhere between 25 and 35 pounds is normal during pregnancy.

Fetal Distress that is not recognized and responded to is negligence and this can cause a birth injury including Cerebral Palsy and other brain injuries to a baby.

Healthcare providers, including both labor/delivery nurses and doctors, must recognize and react to signs of fetal distress. This may include supplemental oxygen, turning the mom and signs of the distress that do not improve or indicate profound fetal distress they must deliver the baby quickly including performing a Cesarean Section (c-section).

There is nothing more traumatic than your child suffering a birth injury. Many birth injuries cause serious medical problems that could end in lifetime disability. The Texas Birth Injury Attorneys at Miller Weisbrod understand the significant impact a birth injury will have not only on your child's life, but also your own. As experienced Birth Injury Lawyers, we fight hard for answers and justice if a delivery room error or doctor's negligence caused your child's birth injury.

If your child suffered a serious birth injury or lifetime disability due to a mistake before, during or after delivery, a lawsuit may be the best way to find out once and for all what happened and who is to blame. Contact our Birth Injury Lawyers today to schedule a free consultation. Call Miller Weisbrod, Attorneys At Law today at 214.987.0005 or toll free at 888.987.0005 for a free consultation.

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