Developmental Follow-Up of Infants Experiencing Perinatal Asphyxia

Neal P. Simon, M.D.

With the first active breaths after birth, a newborn infant sets into motion a cascade of events that ends with the successful transition from an intrauterine to an extrauterine life.  As the lungs inflate, the oxygen level in the infant’s blood rises.  Blood pressure also rises which causes more blood to flow through the now inflated lungs where gas exchange occurs.  Once inflated and filled with blood, the lungs replace the placenta as the organ of respiration.  The lungs are now responsible for continuously bringing oxygen into the blood and eliminating carbon dioxide.

Most newborns have no difficulty in establishing the first effective breaths which trigger this sequence of changes.  If an infant cannot initiate and sustain effective breathing after birth, or if the placenta has malfunctioned before birth, oxygen and carbon dioxide cannot be adequately exchanged resulting in a dangerous drop in the infant’s blood oxygen level accompanied by an increase in the carbon dioxide level and accumulation of acid.  This combination of events is called perinatal asphyxia (literally meaning suffocating). If not quickly corrected, the heart will weaken and the heart rate will dangerously slow, preventing an adequate amount of blood from reaching the organs, especially the brain.  The organs, most importantly the brain, may be damaged, sometimes irreparably.

Perinatal asphyxia occurs in both premature and term infants.   Generally, if the asphyxial episode is mild, infants show no evidence of permanent injury to the brain and no long-term developmental problems.  However, if the asphyxial episode is severe, an infant may die, or survive with life-long neurologic disabilities, including cerebral palsy, mental retardation, vision and hearing impairments, and learning disabilities.  Such problems may not necessarily show up until the infant is older, necessitating the need for long-term monitoring.

Any infant who has experienced perinatal asphyxia should receive special developmental follow-up for the first few years of life.  The goal of developmental follow-up for asphyxiated infants is the identification of potential neurologic and developmental problems with referral to appropriate interventional therapies at the earliest possible age.

During the early period of the follow-up process, an infant should periodically have specific assessments of motor development to detect possible problems with muscle tone (strength) and any evidence of cerebral palsy. Any signs of problems with the muscles warrant subsequent physical and/or occupational therapy evaluations with on-going therapy if indicated.

Oral-motor and swallowing difficulties may also occur in severely asphyxiated infants and interfere with normal feeding.  Some infants only exhibit problems as they experience increasing textures in their food.  The first sign may be unsatisfactory weight gain, as the infant has difficulty in consuming adequate calories.   Feeding difficulties are best addressed by an occupational therapist and/or speech therapist specifically trained and experienced in pediatric feeding problems.  The infant’s primary care provider may also want to perform special x-ray studies to evaluate the oral-motor and swallowing process.

Routine eye and hearing examinations in asphyxiated infants are recommended prior to hospital discharge and again between 6 and 12 months of age (corrected for prematurity).  Additional examinations will be determined according to the type of problems identified.

Developmental and psychological testing is recommended beginning at 1 year of age (corrected for prematurity).  At this age, the higher cognitive areas of the brain are beginning to be used and can subsequently be assessed for any signs of damage.  These assessments include evaluations of intellectual and behavioral skills, and of specific academic abilities at later ages.  These evaluations should be expected to extend through school age as various areas of the brain continue to mature and be increasingly used with age.

Parents should check with their infant’s primary care provider for information on where developmental follow-up can be obtained in their area.

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