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Birth asphyxia (hypoxic-ischaemic encephalopathy)

Encephalopathia hypoxico-ischaemica neonatorum · Porodní asfyxie (hypoxicko-ischemická encefalopatie)

What it is

Oxygen and blood flow to the baby's brain fail around birth; 1–3 per 1,000 births in rich countries, far more where labour care is poor, and about a quarter of newborn deaths worldwide.

Symptoms & signs

  • Not breathing or weak breathing at birth
  • low Apgar score and acidic cord blood
  • floppy, pale, poor suck
  • seizures in the first 1–2 days
  • drowsiness or coma
  • kidney, liver and heart injury
  • later cerebral palsy, epilepsy or learning difficulty

🚩 Get help if…

  • call 112 / 911 now Newborn floppy, not breathing well or hard to wake
  • call 112 / 911 now Jerking, stiffening or staring spells in a newborn
  • call 112 / 911 now Newborn not sucking or not feeding
  • see a doctor soon Stiff or floppy limbs or late milestones in the months after

Where it strikes

Medical treatment

  • Newborn resuscitation — effective breaths with bag and mask come first
  • Cooling to 33.5 °C for 72 hours, started within 6 hours, for moderate or severe encephalopathy in intensive care — trials (TOBY, NICHD, ICE): death or major disability falls by about a quarter (one saved per 7 treated) trials support
  • Cooling in low- and middle-income countries — HELIX trial: no less death or disability, and more deaths (42% vs 31%) not confirmed in trials
  • EEG monitoring and phenobarbital for seizures
  • support of breathing, blood pressure, glucose and fluids
  • brain MRI in the first two weeks to judge outlook
  • developmental follow-up for at least two years

Natural & lifestyle

  • Skilled attendance at every birth and monitoring of labour — the main prevention
  • prompt delivery when the baby is in distress
  • mother's milk once stable
  • early physiotherapy and developmental support

Emerging & experimental

  • Erythropoietin with cooling — HEAL trial: no benefit, more serious adverse events not confirmed in trials
  • Xenon with cooling — TOBY-Xe: no benefit not confirmed in trials
  • Melatonin, allopurinol and umbilical-cord-blood cells — trials under way

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Hyperbaric oxygen for the resulting cerebral palsy — trials: no better than pressurised air not confirmed in trials
  • Cranial osteopathy — untested anecdotal / traditional
  • Stem-cell injections sold abroad — unregulated; infections and tumours reported anecdotal / traditional

ICD codes