Although it is a natural process, birthing a child is fraught with danger. The extreme physical changes a that a child undergoes in enduring contractions or squeezing through the birth canal can expose or exacerbate fetal weaknesses. Even an uneventful pregnancy can turn into an emergency during or after birth when a newborn needs resuscitation. 10% of newborns require help breathing after birth. They may need light manual stimulation, their nose and mouth cleared, or, in more severe cases, chest CPR and a ventilator to start breathing if they do not start on their own after birth. Resuscitation is the term for breathing assistance. The American Academy of Pediatrics recommends that a neonatal resuscitation specialist is present at every birth for optimal preparation for an emergency.

While sometimes, a newborn’s outlook for birth reveals no sign of potential danger before the event itself, moment-by-moment developments in the labor and delivery process can quickly change the situation. A seemingly problem-free childbirth can turn into an urgent, life-threatening situation for a baby who ultimately needs resuscitation after being born. For this reason, it is essential that medical professionals have the requisite knowledge and experience to recognize potential signs that may require immediate intervention to prevent further complications. Recognizing fetal distress in any of its manifestations is crucial, as the need for infant resuscitation may soon follow. Errors while resuscitating a baby can lead to serious birth injuries, some of which have permanent effects. For instance, birth asphyxia may cause brain damage and resulting conditions like Cerebral Palsy and Hypoxic Ischemic Encephalopathy.

Common Indicators of a Baby Needing Resuscitation

Aside from an absent cry at birth, Apgar score measurements within the first minute of life may reveal a newborn’s need for breathing assistance. However, a breathing assessment happens within seconds if the baby does not cry or breathe after birth. Additional troubling indicators are prematurity, meconium in the amniotic fluid, and lax muscles. One of the Apgar measurements is respiration, pulse, appearance, grimace, and movement. A 0 to 2 indicates the vitality of each of the five categories.

Low Apgar scores may indicate a breathing problem, which is more common in premature babies as they are more likely to have underdeveloped lungs unable to expand after the liquid squeezes out of them during birth. The lungs produce surfactant, a hormone to help expand the lungs, late in pregnancy. Thus, premature birth should prompt medical staff readiness in terms of warming the delivery room, having a ventilator on hand, and warm clothing, wrap, and mattress for the newborn preterm baby whose immature lungs may require resuscitation.

Risk Factors for a Infant Resuscitation Situations at Birth

A full-term baby typically does not need resuscitation and can be observed and evaluated while enjoying their first moments of life on their mother’s skin. However, there are other factors that may make resuscitation a necessity regardless of the baby’s gestational age. Aside from prematurity, the list of potential risk factors for a baby needing resuscitation range from instrument-assisted birth, to meconium in the amniotic fluid, shoulder dystocia, breech birth, and irregular fetal heartbeat. In addition, when the mother has group B strep or another infection, her baby is more likely to need resuscitation. Some of the leading risk factors for infant resuscitation include:

Pregnancy Factors 

• Twins and multiple pregnancy
• Gestational diabetes
• Preeclampsia and maternal high blood pressure
• Advanced maternal age
• Maternal infection
• Previous high risk birth
• Larger-than-normal infants (fetal macrosomia)
• Substance use by the mother
• Excessive bleeding during pregnancy
• Placenta previa

Labor and Delivery Events 

• Birth trauma
• Placental abruption
• Premature rupture of the membranes
• Use of forceps or vacuum extractors
• Prolapsed umbilical cord

Recommended Protocol for Infant Resuscitation

The American Academy of Pediatrics (AAP) recommends delaying the umbilical cord clamping for babies who might need resuscitation. However, those who need respiratory support (not breathing and slow heart rate) should be immediately resuscitated first by warming, drying, gentle skin rubbing with a towel, and airway clearing. Suctioning airways should occur only when there is a reason for it; otherwise, it may slow the baby’s heart rate. Medical staff may measure heart rate with a heart monitor and oxygen levels with an oximeter. To stimulate breathing, a doctor may try flicking the baby’s soles of their feet.

If drying, rubbing, and flicking do not work, lung ventilation and expansion are the next steps. Ventilation consists of covering the airways with a mask for a baby who is gasping or has low respiratory functioning. For babies with heart rates below 60 beats per minute, ventilation consists of inserting an endotracheal tube down the newborn’s trachea and pumping oxygen into the lungs. A nasogastric tube (in the nose) may be necessary for young premature babies. A resuscitation specialist knows how to track an infant’s heart rate, C02 output, and oxygen levels while ventilating the lungs to protect the infant’s delicate lung tissue and assess breathing. If the infant’s heart rate is too low, the specialist may have to perform chest compressions. Careful monitoring of chest compressions determines the next step in resuscitation: adding epinephrine, or adrenaline, intravenously to stimulate heart rate.

If an infant is still not responding to chest compressions and medication, a volume expander, a saline solution to coat the lungs, may help the infant’s oxygen levels rise and heart rate stabilize to 60 beats per minute. The expander may be necessary if the newborn has lost too much blood during birth and suffers low blood pressure. In any event, an infant who has had preliminary or advanced resuscitation needs round-the-clock monitoring to ensure the newborn continues to thrive. And if a baby does not respond to chest compressions, medication, and volume expansion, the medical team may face the decision of whether to continue resuscitation after 20 minutes. Some babies are too sick or underdeveloped to survive outside the womb.

The Neonatal Resuscitation Program (NRP) is an AAP and American Heart Association certification program that sets standards for neonatal resuscitation. The recommendations are guidelines for neonatal specialists and all delivery room personnel. They recommend that all premature babies be administered surfactant right after birth or in utero after 30 weeks and suction the nose and mouth for meconium when detected. Further, the NRP indicates the decision to cease resuscitation efforts is a tough decision that requires consultation with the parents.

Possible Consequences of Infant Resuscitation Errors

Aside from NRP recommendations for resuscitation, doctors must be ready for resuscitation. They must know the potential for immediate resuscitation from prenatal complications and individual risk factors.  With infant resuscitation, time is of the essence. All observations and efforts to resuscitate a newborn must come quickly or risk oxygen deprivation and possible brain damage or death. Doctors who recognize of the risks should be acutely aware of possible newborn resuscitation signs and symptoms, but all healthcare providers must be on the lookout for any indication of fetal distress or a baby who needs emergency treatment and breathing assistance. Otherwise, they risk harming the infant through delay or inexpert resuscitation efforts.

The delicate balance of resuscitation machinery, monitoring, and reviving heartbeats requires specialized knowledge of medical professionals who are familiar with the dangers inherent to each newborn, depending on their gestational age and pre-existing conditions and complications. With delayed or insufficient resuscitation, a newborn may suffer brain damage, cerebral palsy, pneumonia, respiratory distress syndrome, or death, among other complications. A physician who does not operate a ventilator properly can cause complications that leave an infant permanently disabled. Cognitive impairments and developmental delays are among the many potential complications from resuscitation errors. Physical disabilities and long-term health problems may also result.

What to do if Your Child has been Injured by Neonatal Resuscitation Errors in New Jersey

When a medical professional fails to live up to the recommended standards of practice, delays emergency resuscitation, or makes errors in the process of infant resuscitation, they may be liable for medical malpractice. Parents and their injured babies do not deserve to suffer the consequences of birth injuries without holding negligent healthcare providers accountable and recovering the compensation they need to support a child’s recovery and long-term needs.

Review your case with an experienced birth injury lawyer on our team if your child’s injuries or complications may be the result of errors during infant resuscitation. Your delivery doctor, medical staff, or resuscitation specialist may have made errors that caused your child’s devastating physical and/or mental damage. Find out from highly knowledgeable and skilled birth injury attorneys if your medical team, physician, birthing facility, or several parties may be liable for malpractice during the labor and delivery process. Call 866-708-8617 to speak to an attorney now about your unique pregnancy and childbirth experience, your baby’s medical outlook, and how we may be able to assist you with recovering the financial support to fund your child’s present and future adaptive and medical needs.

Resources:

• https://pubmed.ncbi.nlm.nih.gov/26282500/
• https://pubmed.ncbi.nlm.nih.gov/20172885/
• https://www.ahajournals.org/doi/10.1161/circulationaha.110.971119