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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Limp, Bradycardiac, Without Spontaneous Breathing During Birth, No Response For Vigorous Stimulation. Diagnosed Severe Asphyxia. Treatment?

May I ask about ASPHYXIA severe.
Baby Kearney was born via NSD with APGAR score of 2,3 and 5, Ballard score of 39-40wks & birth weight of 3.09kg.At birth, he was limp, bradycardiac & no spontaneous breathing. Vigorous stimulation and drying was done but still no response. Hence intubated and hooked to mechanical ventilation and was admitted in the hospital where his mother had given birth with the case of ASPHYXIA, severe.
May I then ask for help. May I ask what actions we may do to help the baby. He is always asleep with his eyes open for how many minutes and v.v. Thank you.
Thu, 25 Jul 2013
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Pediatrician,  's  Response
This is truly a tragic situation and I'm afraid I can't give you a definite answer. I have some questions about the birth though as it sounds like he was really an Apgar 1 since he required full resuscitation after not responding to stimulation. I suspect there was an issue during labor immediately before delivery with the placenta or umbilical cord leading to perinatal asphyxia since he was born unresponsive with just a heartbeat (thus Apgar 1). The fact that he never really responded to resuscitation efforts at birth and there was a delay in getting him on a ventilator and fully oxygenated does not bode well for his eventual recovery. If he is on a ventilator with no spontaneous breaths and unresponsive then it is likely that he suffered a severe injury to his brain and brainstem and thus may not be able to be taken off the machine.
Only time will tell and certainly, though I don't know how old he is now, it is worth waiting for a few days to see if he wakes up. Tests can be done to look at his brain function (EEG, brain scan, etc) but if he will not breathe on his own the the choice will need to be made whether to take him off the ventilator to see if he will breathe, and if not he will die, or just to leave him on the machine indefinitely.

I'm sorry not to be able to tell you more or offer any encouragement but I've seen this happen too many times to be optimistic.
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Limp, Bradycardiac, Without Spontaneous Breathing During Birth, No Response For Vigorous Stimulation. Diagnosed Severe Asphyxia. Treatment?

This is truly a tragic situation and I m afraid I can t give you a definite answer. I have some questions about the birth though as it sounds like he was really an Apgar 1 since he required full resuscitation after not responding to stimulation. I suspect there was an issue during labor immediately before delivery with the placenta or umbilical cord leading to perinatal asphyxia since he was born unresponsive with just a heartbeat (thus Apgar 1). The fact that he never really responded to resuscitation efforts at birth and there was a delay in getting him on a ventilator and fully oxygenated does not bode well for his eventual recovery. If he is on a ventilator with no spontaneous breaths and unresponsive then it is likely that he suffered a severe injury to his brain and brainstem and thus may not be able to be taken off the machine. Only time will tell and certainly, though I don t know how old he is now, it is worth waiting for a few days to see if he wakes up. Tests can be done to look at his brain function (EEG, brain scan, etc) but if he will not breathe on his own the the choice will need to be made whether to take him off the ventilator to see if he will breathe, and if not he will die, or just to leave him on the machine indefinitely. I m sorry not to be able to tell you more or offer any encouragement but I ve seen this happen too many times to be optimistic.