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Perinatal Asphyxia

  • Cynthia M. Johnson, MA
Publication Type:


Perinatal Asphyxia

(Hypoxic Ischemic Encephalopathy; HIE; Cerebral Hypoxia)


Perinatal asphyxia can happen when a baby’s brain does not get enough oxygen before, during, or after birth. This can damage to the brain.

Perinatal asphyxia can be fatal. Brain cells can begin dying within as little as 5 minutes without oxygen. It can also cause lasting harm, including intellectual disability, delayed development, seizure disorder, and cerebral palsy.


Perinatal asphyxia can be caused by health problems that stop or slow the normal blood and oxygen flow to the baby's brain before or during labor and delivery. Some things that may cause these problems include:

  • A drop in the pregnant person's blood pressure
  • Pressure on the umbilical cord that stops the flow of blood to the baby
  • Placental abruption, where the placenta moves away from the wall of the uterus, and other problems with it

Risk Factors

Things that may raise a baby’s chance of perinatal asphyxia include:

  • Fetal heart rate problems
  • Water breaking more than 12 hours before delivery
  • Meconium (infant bowel contents) in the fluid around the baby before birth
  • Hemorrhage that happens before birth
  • Infection in the pregnant person that may cause breathing problems, such as pneumonia
  • First and second stages of labor taking a very long time
  • Pre- or post-term labor
  • Delivery with forceps or a vacuum device


Mild asphyxia may cause:

  • Poor muscle tone
  • Irritability
  • The baby to be very drowsy
  • Problems feeding

Severe asphyxia may cause:

  • Seizures
  • The baby to have a hard time waking up
  • Blue-colored skin or lips
  • Trouble breathing


A physical exam will be done. Often the history of the pregnancy and birth are the most important things needed to make the diagnosis.

Tests may be done of the baby's:
  • Blood
  • Urine
  • Stool
  • Fluid around the brain and spine

Images may need to be taken of the baby’s organs. This can be done with:

Tests may be done to check how the baby's heart and brain are working. This can be done with:



For most babies asphyxia is sudden and cannot be prevented.

Life-sustaining Treatment

The goal of treatment is to help get oxygen back into the baby's brain. The baby may be given oxygen or put on mechanical ventilation to help them breathe. These treatments will be stopped as the baby gets better.


Medicine may be given to help the heart work until the baby gets better. Medicine and general anesthesia may also be given to control seizures.

Lowering Body Heat

The baby may be wrapped in cooling blankets within hours of birth. This can help reduce the risk of long term problems.





  • Birth asphyxia. Seattle Children's website. Available at: https://www.seattlechildrens.org/conditions/birth-asphyxia.
  • Harrington, D.J., Redman, C.W., et al. The long-term outcome in surviving infants with Apgar zero at 10 minutes: a systematic review of the literature and hospital-based cohort. Am J Obstet Gynecol, 2007; 196 (5): 463.e1-e5.
  • Lai, M.C. and Yang, S.N. Perinatal hypoxic-ischemic encephalopathy. J Biomed Biotechnol, 2011; 2011: 609813.
  • Neonatal hypoxic-ischemic encephalopathy (HIE). EBSCO DynaMed website. Available at: http://www.dynamed.com/condition/neonatal-hypoxic-ischemic-encephalopathy-hie-21.


  • Chelsea Skucek, MSN, BS, RNC-NIC
Last Updated:

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.