Breathing problems in newborns

Hypoxic Ischemic Encephalopathy (HIE)

A 2 hour old neonate was brought to the emergency department of Ovum hospital with complaints of low or no breathing. The child was delivered in another hospital and when he was in a critical condition when he was brought to Ovum. This was evidenced by a decreased body tone in the neonate – warranting immediate medical intervention. 

“My son was not breathing normally and was very tired and flaccid, I had to rush him to Ovum Hospital” –Father of the newborn.

Breathing difficulties in newborns can take direct impact on critical organs such as brain. The brain is the commonest organ damaged due to decrease in oxygen content in the blood supply to brain, a condition called hypoxic ischemic encephalopathy (HIE). This happens just before or just after the birth of baby. HIE can be identified when

  1. Change in skin color – pale or bluish tinge
  2. Poor muscle tone
  3. Weak/ no breathing
  4. Low heart rate
  5. Excessive acid in blood
  6. Seizure in severe HIE

Ovum’s pediatrician examined for tone of the child, heart rate, breathing and the child’s blood showed an acidic pH of 7.01 along with other supportive tests. The child was immediately shifted to ICU for management and active resuscitation, fluid management including blood glucose monitoring was performed and the child was subjected to therapeutic hypothermia (cooling of body).

The standard of care for HIE is to start cooling infants after 6 hours from birth to a body temperature of 33.5o C and 34.5o C and maintaining this without interruption for 72 hours. This is followed by re-warming over atleast 4 hours at 0.5OC/ hr till it reaches the regular body temperature (36.5-37.5oC).

The oxygen deficit can cause damage to the brain. The baby’s oxygen levels were monitored and provided the cooling to ensure neonate is protected against HIE. The NICU of Ovum hospital is equipped with total body cooling facilities which very few centers in India have.

“The doctor’s response was quick, they understood the critical nature and severity of the situation, kept us informed of the situation”. – Mother

The children should be monitored both short-term and long-term, the goal is to detect any impairments and intervene accordingly. All children with moderate HIE should be followed by paediatrician and neurologist along with eye specialist and hearing tests.

Children with mild HIE are shown to do well and my not need any follow-up.

The baby recovered well, there was no episode of seizures and tone had returned to normal, and the baby was discharged after 2 weeks. The parents have been advised for regular follow-up and monitoring.

“Ovum hospital has been a great support for us. They brought back my child’s health and I am very thankful to the dedicated team of pediatricians, NICU staff and nurses who took immense care along with compassion”- Shobha and Chitti Babu (Parents)