Perinatal Resuscitation

When a baby is in fetal distress during labor or childbirth, there is only a short amount of time to act to try and restore blood and oxygen flow to the brain. In an adult, resuscitation can begin immediately. However, resuscitation cannot begin on a baby in the womb until the baby is delivered. After delivery, there needs to be a team available to immediately begin resuscitation. 

What is Perinatal Resuscitation?

Resuscitation generally refers to the process of reviving someone from unconsciousness or correcting a physiological disorder.  The most familiar form of resuscitation is CardioPulmonary Resuscitation, or CPR. CPR is an emergency procedure to provide functioning when the heart has stopped beating. This may include using breaths and chest compressions which restores some oxygenation of the blood and helps pump the blood throughout the body to keep the organs alive. 

Resuscitation can be performed on an infant in a non-hospital setting, which is similar to CPR in adults, giving gentle breaths and chest compressions. However, when a baby is not breathing before, during, or immediately after delivery, resuscitation is generally performed in the hospital with a specialized team using instruments intended for use in an infant.

Simple resuscitation can be accomplished through stimulation at birth to help them breathe. This generally involves drying and rubbing the child to get the child breathing on its own. If this does not restore breathing function, the baby may require basic resuscitation, using bag-and-mask ventilation. In severe cases, the baby may require intubation, chest compressions, and drugs to restore function. 

According to the American Academy of Pediatrics (AAP), “approximately 1 million neonatal deaths occur each year due to perinatal asphyxia.” Perinatal asphyxia is a medical condition where the baby suffers a decrease or loss of oxygen supply through the blood. If asphyxia goes on too long, it can cause irreversible neurological damage. 

Perinatal resuscitation can restore oxygenated blood to the baby's brain and vital organs, to reduce the risk of death and disability. This generally requires an open airway, adequate breathing, and circulation of oxygenated blood. 

Prenatal vs. Perinatal

Perinatal and prenatal are terms that may overlap and cause some confusion for patients. Prenatal is the period leading up until birth and perinatal is the period around the birth, which may include before, during, and immediately after. Neonatal is the period after the child is born. 

When is it Necessary to Perform Perinatal Resuscitation?

The transition from intrauterine to extrauterine life for a baby is a critical time. During the pregnancy and up until birth, the baby receives all of its nutrients, blood, and oxygen from the mother through the umbilical cord. While in the womb, the baby does not need to breathe on its own, relying on the mother's lungs and heart to circulate oxygenated blood throughout both bodies. When the baby is born, it can no longer rely on the umbilical cord for oxygen and has to begin breathing on its own. 

Most newborns are able to transition from inside the womb to outside the womb without a problem. However, about 10% of newborns require assistance to be able to breathe and get oxygen. Delivery teams are generally prepared for this possibility and standing by with the appropriate resources available.  

Children may stand the best chance at recovery when there is early identification of risk factors for difficulties during childbirth. This may involve ongoing screening and monitoring to look for signs or risk factors that the baby may potentially require resuscitation. Some of the risk factors of birth complications for the mother may include: 

  • Gestational diabetes
  • Pre-eclampsia
  • HELLP syndrome
  • Serious medical conditions
  • High blood pressure
  • Alcohol or drug use
  • Maternal age over 40
  • Prior birth complications
  • Previous preterm birth
  • Trauma
  • Anemia
  • Infection

There may also be signs of fetal distress or developmental problems during the pregnancy that may put the newborn at a higher risk for requiring resuscitation after delivery. Some fetal risk factors include: 

  • Multiple births
  • Gestational age over 30 weeks
  • Fetal anomalies
  • Breech preterm
  • Intrauterine growth restriction
  • Excessive or reduced amniotic fluid

During delivery, there are also risk factors associated with the possible need for perinatal resuscitation. Some of the risk factors during delivery may include: 

  • Emergency cesarean (C-section)
  • Use of forceps or vacuum extractor
  • Fetal distress
  • Prolonged PROM
  • Placental abruption
  • Prolonged labor
  • Meconium staining
  • Umbilical cord prolapse or nuchal cord

Evaluating the Need for Resuscitation

Recognizing the need for resuscitation may involve a number of primary evaluations, including determining: 

  1. Is the child full-term?
  2. Is the baby breathing or crying?
  3. Does the baby have good muscle tone?

Preterm babies are much more likely to require resuscitation. A preterm baby may not have full lung development, be more sensitive to injury or hemorrhage, and have heat retention difficulty. Preterm babies may also be more at risk of developing an infection. 

One of the first things a mother may notice is when a baby is born and does not make any sounds. If the baby is not breathing or is gasping for air, the baby may require immediate resuscitation to restore oxygenation of the blood. Poor muscle tone may also be a sign of inadequate oxygenation in the blood. 

Who Performs Perinatal Resuscitation?

Who performs the perinatal resuscitation may depend on the situation. Initial treatment may be performed by a nurse or obstetrician. In severe cases, where the baby needs to be intubated and put on a ventilator, resuscitation may be performed by an anesthesiologist

Intubation and Resuscitation

Intubation is the medical procedure to maintain an airway and access to the lungs. Intubation and ventilation may be required after delivery if the child needs resuscitation. Intubation may be more complicated with a neonate or infant because of the smaller size of the mouth, throat, and tracheal opening. 

In the emergency intubation of a neonate, the anesthesiologist may use sedatives and analgesics to minimize the effects of intubation. However, there may be side effects associated with the anesthetic drugs, which may include:

  • Allergic reaction 
  • Rapid heart rate 
  • Low blood pressure
  • Depressed central nervous system
  • Lower breathing rate
  • Arrhythmia
  • Hyperkalemia

Errors During Resuscitation and Complications

Errors can occur throughout the childbirth process leading to resuscitation. Even during resuscitation efforts, the doctors and nurses can make mistakes that put the baby at risk of injury or harm. Parents may not be aware of the standard of care for perinatal resuscitation and they may not notice when the doctors fail to follow the rules. There may be complications during even the most basic steps for resuscitation, including: 

  • Thermal protection: hypothermia, cold stress, or too much heat causing extensive burns
  • Proper positioning: flexion or hyperflexion
  • Airway clearing: rough suctioning against the pharynx may cause apnea or bradycardia
  • Stimulation: inadequate, prolonged, or vigorous stimulation may cause serious damage

Consequences of Perinatal Resuscitation Errors

The greatest consequence for a family after perinatal resuscitation errors is the loss of the child's life. It is devastating for parents to lose a child but even more painful when they learn that death was avoidable and caused by a medical mistake. 

Oxygen Deprivation

If the child does survive even after resuscitation errors, the child may still be left with permanent injuries. Some of the most severe complications are caused by oxygen deprivation. Oxygen deprivation could be caused by delayed delivery, delayed resuscitation, improper resuscitation, or improper intubation. 

Any lack of oxygen caused by medical malpractice can cause severe brain damage. The parents may not even understand the extent of the brain injury until years later. Developmental delays may start to show after 2 or 3 years, when the baby begins to miss developmental milestones. 

Other birth injuries associated with oxygen deprivation include:

When a child suffers a birth injury because of medical malpractice, the injury may follow them for the rest of their lives. A child with permanent brain damage may require care for their basic needs. Parents also have to plan for how to care for their special needs child after they pass away. Past and future medical care is expensive and when the injury was caused by a medical error, the people who caused the injury should be held accountable. 

Perinatal Resuscitation Malpractice Lawyer

Perinatal resuscitation should be something all delivery teams should be aware of and prepared for. When a child is born preterm, is not breathing, or has poor muscle tone, the medical team needs to act quickly. Any delay in treatment can put the baby at risk of injury or death. 

Unfortunately for parents, the doctors and the hospital may not come forward and admit to making a mistake. Even if the parents suspect something went wrong, it can be a struggle to get answers. Calling an experienced birth injury medical malpractice attorney may be the next step to getting the answers you need.  

The hospital and doctors will take your case seriously with an experienced attorney on your side. A medical malpractice lawsuit will allow you to recover damages and losses, including medical care, future medical treatment, loss of support, and pain and suffering. 

If you suffered negligent medical care during childbirth, talk to an experienced birth injury malpractice attorney about your options for recovery. Do not hesitate to contact Gilman & Bedigian today for a free consultation.

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