Risk Factors and Causes of Neonatal Resuscitation Errors May 7, 2024.

Risk Factors and Causes of Neonatal Resuscitation Errors

Babies rely on their mothers for everything while they are developing in the womb. This includes breathing. The mother’s placenta helps the baby “breathe” by transferring carbon dioxide and oxygen through the blood.

But, after birth, babies have to quickly adjust and use their lungs to breathe on their own. Most babies can make this adjustment, with no issues. However, about 10% of babies have complications breathing on their own after birth. This requires emergency medical intervention called “neonatal resuscitation”. This means that the baby needs medical assistance to help them adjust to breathing with their lungs.

How Do Doctors Determine If a Baby Needs Neonatal Resuscitation?

Medical providers will perform the Apgar test to evaluate the baby. This evaluation is done to see if the baby needs medical intervention.
The Apgar test stands for:

  • Appearance: Viewing the baby’s skin to make sure it is turning pink.
  • Pulse: Assessing their heartbeat strength and heart rate.
  • Grimace: Seeing if the baby responds to stimulation.
  • Activity: Assessing their muscle tone to make sure it is normal.
  • Respiration: Listening to make sure the baby is crying and breathing normally.

Each category is given 0-2 points based on how the baby is adjusting. An Apgar score of 7 or higher means that the baby is doing well. However, a lower score could indicate that there is a serious problem going on.

If the medical professionals determine that the baby needs help breathing, then neonatal resuscitation will begin.

Neonatal Resuscitation Procedure

When a newborn is showing signs of weak breathing, doctors who specialize in neonatal resuscitation need to quickly jump into action.

The steps of neonatal resuscitation are as follows:

  • Step 1: Drying, warming, repositioning, and clearing the baby’s airway
  • Step 2: Ventilation
  • Step 3: Chest compressions
  • Step 4: Doctors will administer epinephrine

Each step is completed within 30 seconds, and the doctors continuously evaluate the baby’s heartbeat, color, and respiration. If the baby’s condition is improving then the resuscitation process will stop, and the baby will be given to their mother. But, if the baby is not improving, then doctors will move on to the next step.

At any step of this process, the doctors may decide to intubate the baby. Intubation is when a tube is placed down the patient's throat and into the trachea. The tube keeps the airway open, to help them breathe.

Risk Factors of Neonatal Resuscitation

During high-risk pregnancies, there are usually signs that the baby will need assistance with breathing once out of the womb. It is the doctor’s and nurses’ job to be aware of the risk factors of needing neonatal resuscitation, so they can be prepared if any complications arise.

Babies who have the following risk factors are more likely to need neonatal resuscitation:

  • Meconium in the amniotic fluid
  • High birth weight
  • Premature birth
  • Maternal infection
  • Preeclampsia
  • Prolapsed umbilical cord
  • Fetal growth restriction
  • Breech position
  • Multiple births (twins, triplets)
  • Fetal distress
  • Congenital abnormalities that affect breathing
  • Prelabor rupture of membranes
  • Cesarean section

However, even during an uneventful pregnancy, some babies need assistance breathing once out of the womb. Even if there is no indication that the baby will need resuscitation, it is the medical provider's responsibility to be ready to treat the baby.

Common Neonatal Resuscitation Errors

Unfortunately, in high-stress situations, errors can occur before or during the neonatal resuscitation process. If the baby does not get proper treatment due to these errors, they may sustain significant injuries or even death.
Common errors that occur before and during neonatal resuscitation include:

  • Failure to recognize fetal distress
  • Intubation errors
  • Delayed resuscitation
  • Miscommunication between doctors and nurses

Failure to Recognize Fetal Distress

Fetal distress can usually be diagnosed with proper monitoring of the mother and baby throughout labor. Common signs of fetal distress include an abnormal heart rate, meconium in the amniotic fluid, and a decrease in movement.

It is the medical provider’s responsibility to have the skill and equipment to diagnose and treat fetal distress, so the baby does not suffer birth asphyxia. Birth asphyxia occurs when the baby does not get enough oxygen before or just after birth. Sadly, this complication can lead to permanent complications like hypoxic-ischemic encephalopathy or cerebral palsy.

Intubation Errors

Doctors have little room for errors while intubating a patient. However, they have to be even more careful when intubating a baby, due to how small and fragile they are. Unfortunately, even experienced doctors can make intubation errors.
Common neonatal intubation errors include:

  • Delayed intubation
  • Failure to intubate
  • Intubation of the esophagus, not the trachea
  • Damaging the trachea

Intubation errors can cause significant injuries to the baby and may make it even harder for the baby to breathe.

Delayed Resuscitation

Neonatal resuscitation needs to occur quickly to mitigate the risk of significant injury. If the baby comes out of the womb and is gasping for air or has a low heart rate, ventilation needs to start within 60 seconds. The longer it takes for ventilation to start, means that the risk of birth asphyxia increases. Sadly, every 30 seconds that ventilation is delayed, the risk of serious injury or death increases by 16%.

Miscommunication Between Doctors and Nurses

Clear communication is essential during a high-stress situation, such as neonatal resuscitation. The obstetrician team is in charge of alerting the resuscitation team if the baby is at high risk of needing resuscitation. If the obstetrician miscommunicates, then the resuscitation team may not be prepared to do their job.

Neonatal resuscitation teams should be well-organized and have a plan on how to manage different levels of resuscitation. All of the team members should know what task they will perform, the risk factors, and the equipment that will be needed.

Unfortunately, not all healthcare facilities have these teams in place to jump into action if a baby needs resuscitation. This leads to miscommunication and mismanagement of the situation.

Sadly, with chaotic and unorganized environments, healthcare providers are more prone to making mistakes.

Consequences of Errors

Any time there is a lack of oxygen to the brain, there is a risk for severe brain injuries. There are long-term consequences for the baby, and family, that can occur if a medical provider makes errors during neonatal resuscitation.
Consequences of neonatal resuscitation errors include, but are not limited to:

  • Increased risk of neonatal mortality
  • Long-term health issues
    • Conditions such as cerebral palsy and hypoxic-ischemic encephalopathy can occur after neonatal resuscitation errors.
  • Psychological impact on family
    • Family members may experience depression and anxiety.
  • Financial impact
    • The family may struggle to pay for the medical treatments that their child needs.

Meet With an Experienced Cleveland Birth Injury Attorney

If your baby was the victim of neonatal resuscitation errors, you may be able to receive legal assistance. Of course, in some instances, birth injuries can occur even if the doctors did everything right. However, there is a huge problem if the baby sustains severe injuries due to a medical provider’s errors.

At The Mellino Law Firm, we understand the devastating impact that neonatal resuscitation errors will have on the baby, as well as the family. Our firm is dedicated to helping families like yours recover compensation after medical negligence harms your baby.

Contact us today to schedule a free initial consultation to learn more about how we can help your family, by calling our office at (440) 333-3800 or filling out our contact form.