Birth Asphyxia

What is birth asphyxia?

Asphyxia (as-FIX-ee-uh) means lack of oxygen and blood flow to the brain. Birth asphyxia happens when a baby’s brain and other organs do not get enough oxygen and nutrients before, during or right after birth. This can happen without anyone knowing. Without oxygen and nutrients, cells cannot work properly. Waste products (acids) build up in the cells and cause damage.

The amount of harm depends on:

  • How long your baby does not get enough oxygen
  • How low the level of oxygen is
  • How quickly the right treatment is given
  • Do babies recover from birth asphyxia?

    Babies with mild or moderate asphyxia may recover fully. If the cells did not get enough oxygen for a longer time, a baby may have permanent injury. This could affect their brain, heart, lungs, kidneys, bowels or other organs.

    Body cooling (therapeutic hypothermia) can improve outcomes for babies born at full term or near term. But babies born 5 or more weeks early cannot have body cooling. In the most severe cases, asphyxia can lead to organ failure and death.

  • Stages of birth asphyxia

    Two stages of injury can happen with birth asphyxia:

    • The first stage happens within minutes if blood flow is low and cells do not get enough oxygen.
    • The second stage is called “reperfusion injury.” It can last for days or even weeks. This injury happens after the brain starts getting normal levels of blood and oxygen. Toxins released from the damaged cells cause this injury.
  • What causes birth asphyxia?

    Some causes of birth asphyxia include:

    • Too little oxygen in the mother’s blood before or during birth
    • Problems with the placenta separating from the womb too soon
    • Very long or difficult delivery
    • Problems with the umbilical cord during delivery
    • A serious infection in the mother or baby
    • High or low blood pressure in the mother
    • Baby’s airway is not formed properly
    • Baby’s airway is blocked
    • Baby’s blood cells cannot carry enough oxygen (anemia)

Birth Asphyxia at Seattle Children’s

We have a great deal of experience treating babies with birth asphyxia. Seattle Children’s newborn care experts treat the sickest babies. At Seattle Children’s, you are a key member of your baby’s healthcare team. Together, we work to improve your baby’s quality of life, not just meet their medical needs.


  • The experts you need are here

    Our 32-bed Neonatal Intensive Care Unit (NICU) is the first in the state to be designated level IV. That’s the highest level possible.

    We are the only hospital in the Pacific Northwest that provides 24/7 access to all the pediatric medical and surgical specialists your child may need. We stay in close communication with you – and with each other – to plan and provide the best treatment for your child.

  • The most advanced treatments

    We provide the most advanced treatments and services in the region. Some are offered nowhere else in the Northwest. We can monitor and treat babies even when 1 or more body organs have failed.

    • Body cooling (hypothermia) to reduce the risk of brain injury in babies with asphyxia.
    • Extracorporeal life support (ECLS) that does the work of your baby’s heart or lungs if they are not working well and need time to heal. “Extracorporeal” means outside the body. It is also called ECMO. Our life support team has some of the nation’s best outcomes.
    • State-of-the-art breathing support. As needed, we treat your newborn with breathing machines (ventilators) or inhaled nitric oxide (iNO) to open the blood vessels in the lungs.
    • Neuro NICU with cutting-edge technology to keep a careful watch on your baby. Near-infrared spectroscopy (NIRS)  measures blood flow in their brain. Video electroencephalography (EEG) helps us monitor brain activity. We use noninvasive MRI (magnetic resonance imaging) to make pictures of your baby’s brain without radiation.
    • The largest team of anesthesiologists who specialize in treating only babies and children. Managing your baby’s pain is critical to their healing.
    • Continuous dialysis to filter their blood if your baby has kidney failure.
    • Mobile life support, including ECLS if needed, to bring babies to Seattle Children’s from anywhere in Washington, Alaska, Montana, Idaho, Hawaii or Oregon. We also can use body cooling during transport.
  • National research leaders

    Our neonatologists are internationally known for their work to protect and heal the brains of babies who did not get enough oxygen at childbirth. We are committed to improving treatments for babies with asphyxia so they have the best possible chance at a healthy life.

    Babies in our care can take part in research studies of promising new treatments. These are called clinical trials.

    Dr. Sandra “Sunny” Juul co-leads a multicenter national study that uses high doses of the hormone erythropoietin (Epo) combined with body cooling to treat babies with asphyxia. Researchers will test the babies’ thinking and movement at age 2. The goal is to save lives and improve outcomes. The multicenter study is called HEAL (High-dose Erythropoietin for Asphyxia and Encephalopathy). This work builds on earlier research by Dr. Juul and Dr. Dennis Mayock.

    Our physician-scientists also:

    • Study and test innovative mechanical heart devices. Our goal is to develop safer, more effective devices for children with breathing problems or very weak hearts.
    • Look for the best ways to reduce stress in the NICU and relieve pain. They also study the long-term effects of stress and pain on the developing brain.

    Learn more about Seattle Children’s research to improve newborn care.

  • Support for your whole family
    • At Seattle Children’s, your family has a full team behind you. We offer a comforting environment for you and your family.
    • We work with you to make decisions and treatment plans for your baby. We invite you to share your insights, questions and concerns during daily meetings of your baby’s healthcare team. The meetings are called “rounds.” Consultations are available to help you sort through confusing or difficult medical issues.
    • We work with many children and families from around the Northwest and beyond. We can help with financial counseling, housing, transportation, interpreter services and spiritual care. Our goal is to get you and your baby home – or back to a hospital close to home – as soon as possible.

Symptoms of Birth Asphyxia

Symptoms of asphyxia at the time of birth may include:

  • Not breathing or very weak breathing
  • Skin color that is bluish, gray, or lighter than normal
  • Low heart rate
  • Poor muscle tone
  • Weak reflexes
  • Too much acid in the blood (acidosis)
  • Amniotic fluid stained with meconium (first stool)
  • Seizures

Diagnosing Birth Asphyxia

At birth, doctors and nurses check your baby’s condition carefully and give a number rating from 0 to 10. This number is called an Apgar score. The Apgar rates skin color, heart rate, muscle tone, reflexes and breathing effort. A very low Apgar score (0 to 3) lasting longer than 5 minutes may be a sign of birth asphyxia.

The doctor will check your baby for other signs of a lack of blood flow or oxygen. These include:

  • Abnormal breathing
  • Poor blood circulation
  • Lack of energy (lethargy)
  • Low blood pressure
  • Not peeing
  • Blood-clotting abnormalities

Treating Birth Asphyxia

If your baby has mild asphyxia at birth, they will get breathing support until they can breathe well enough on their own. We watch them closely for signs of problems.

Babies with more serious asphyxia may need:

  • Breathing support from a machine that sends small, rapid puffs of air into your child’s lungs. Some babies may need nitric oxide through a breathing tube or a heart-lung pump for life support.
  • Body cooling (hypothermia).
  • Medicine to control blood pressure.
  • Kidney support with dialysis.
  • Medicine to treat seizures.
  • Intravenous (IV) nutrition to give their bowel time to recover.

When needed, we provide these advanced treatment options:

  • High-frequency ventilation

    High-frequency ventilation uses a breathing machine that sends small, quick puffs of air into your baby’s lungs. It is more gentle than a regular breathing machine, which sometimes uses high pressure that can damage fragile newborn lungs.

  • Inhaled nitric oxide

    Inhaled nitric oxide is used if your baby has respiratory failure or high blood pressure in the lungs (pulmonary hypertension). Your baby will get nitric oxide through a breathing tube into their airway. This helps open (dilate) the blood vessels in their lungs so the vessels can carry oxygen-rich blood around the body.

  • Hypothermia

    Research shows that cooling a baby’s internal body temperature to 33.5 degrees C (about 91 degrees F) for 72 hours can help protect their brain from damage during the second stage of asphyxia. This stage (reperfusion) is when normal blood flow and oxygen are restored to the brain. This treatment works best to reduce brain damage if it is started within 6 hours after birth. This treatment is only used if babies are at least 35 weeks’ gestation (not more than 5 weeks early).

  • Extracorporeal life support (ECLS)

    Extracorporeal life support uses a heart-lung pump to provide temporary life support when a baby’s heart or lungs are not working well or need time to heal. “Extracorporeal” means outside the body. Oxygen-poor blood is drawn into a machine that removes carbon dioxide, adds oxygen and then returns the oxygen-rich blood to the baby’s body. We will give your baby sedation while on ECLS. A nurse and an ECLS specialist will closely monitor your baby. The ECLS machine used to be called extracorporeal membrane oxygenation (ECMO).

  • Follow-up treatment

    Babies born too soon (premature) or those who did not get enough oxygen during birth may have permanent injury. This may affect their brain, heart, lungs, kidneys, bowels or other organs.

    Babies with asphyxia may develop: 

    After your child receives any urgent or emergency treatment they need, the team at Seattle Children’s plans and provides ongoing care so your child has the best possible outcome. We evaluate all your child’s health needs and work with you to create a care plan that fits your child and family. Catching problems early and getting a referral to specialists may improve outcomes for your child.

Contact Us

  • For more information about Neonatology, contact us at 206-987-2675.
  • If your baby is in our NICU and you need to reach a nurse, call 206-987-2041.