Overventilation Injuries in Newborns Birth Injury Lawsuits

Many newborn infants require help breathing through mechanical ventilators. Neonatal ventilators can be life-saving devices when properly operated, but they can also pose a hidden danger. Newborn breathing machines are complex and must be set up properly and closely monitored by trained professionals.

If not properly used, infant breathing machines can actually take too much carbon dioxide from the baby’s blood (hypocarbia). This is called overventilation. Hypocarbia from overventilation can cause serious damage to a newborn’s brain and lungs.

Neonatal Ventilation Injuries

Many babies are born with respiratory problems that make it difficult for them to get sufficient oxygen by breathing on their own. Being born prematurely, meconium aspiration syndrome, or apnea are some of the most common reasons for neonatal respiratory problems. Newborns with respiratory difficulties are typically transferred to a NICU and put on mechanical ventilation to help them get sufficient oxygen until they can breathe okay on their own.

Despite their obvious life-saving abilities, infant respirator devices can actually be harmful to the baby if not properly used and managed. The main risk posed by improper use of neonatal respiratory devices is hypocarbia from overventilation. Overventilation occurs when the respiration device causes the baby to draw breaths that are too deep and/or too fast (similar to hyperventilation). When this occurs, it can cause too much carbon dioxide to be removed from the baby’s system too quickly, triggering abnormally low CO2 levels in the bloodstream.

When carbon dioxide levels in the bloodstream become too low (a condition called hypocarbia), it can result in an acute reduction of blood circulation to critical areas of the baby’s brain. Reduced cerebral blood flow can have devastating consequences for newborns. It will cause permanent destruction of brain cells and tissues resulting in serious neurologic birth injuries such as cerebral palsy. Hypocarbia from overventilation has also been linked to periventricular leukomalacia (PVL).

Misuse or negligent monitoring of neonatal ventilators can also cause serious damage to the baby’s lungs. Excessive pressure from mechanical ventilation can cause scarring or collapse of a newborn’s lungs. It can also cause neonatal lung conditions such as pneumothorax and bronchopulmonary dysplasia.

Causes of Overventilation in Newborns

There are a variety of different neonatal respiration devices, but they generally fall into 1 of 2 categories: mechanical or bag. Overventilation and hypocarbia in newborns can occur with all types of mechanical or bag ventilation devices (although some are more likely than others). The mistakes that can lead to overventilation vary depending on which type of assisted ventilation is being used.

• Mechanical Ventilation: mechanical ventilators for newborns (also known as breathing machines) are automated devices that either assist the newborn with breathing or completely breathe for them. Mechanical ventilators have displays that tell doctors and nurses exactly how much air is being delivered into the baby’s lungs. They also have pressure gauges that allow doctors to constantly monitor the air pressure level in the lungs. Even with these advanced monitoring capabilities, however, overventilation can still occur with a neonatal breathing machine. The monitoring capabilities of the machine are only effective if the NICU team pays attention and knows how to interpret them. Sometimes, an inexperienced NICU staff member may misinterpret or overreact to data on the breathing machines and increase the oxygen levels too much. The danger with mechanical ventilators is that small adjustments can quickly cause acute drops in CO2 levels in the blood (hypocarbia).
• Bag Ventilation: with a bag ventilator, the baby either has a breathing tube inserted in the windpipe or an oxygen mask held over the nose and mouth. This is attached to a bag that doctors or nurses manually compress in order to force air into the baby’s lungs. This is frequently called “bagging” or positive pressure ventilation (PPV). Bagging is often employed in emergency situations (such as neonatal CPR) when there is not enough time to set up a mechanical ventilator. Since air is delivered by hand, there is no way to measure the level of oxygen or CO2, which creates a risk of overventilation.

Risk Factors for Overventilation Birth Injuries

Birth injuries from overventilation are only possible if the baby requires breathing assistance after birth. This means the risk factors for overventilation injuries are basically the risk factors for babies with respiratory difficulties that require ventilation. Babies with the following conditions are much more likely to have breathing issues and require respiratory assistance:

• Prematurity: Babies who are born prematurely have the highest risk of breathing problems because the lungs are one of the last things to develop during fetal gestation.
• Oxygen Deprivation During Delivery: If the baby suffers any type of oxygen deprivation due to complications or stress during labor and delivery, they are more likely to require mechanical breathing assistance.
• Meconium Aspiration: Meconium aspiration syndrome occurs when a baby inhales meconium (fecal material from the baby’s first stool) inside the womb before birth.

Signs of Overventilation Injuries in Newborns

Usually when a newborn suffers an overventilation injury it occurs immediately after birth during emergency bagging or later on at the NICU while on the ventilator. Possible signs and symptoms that a newborn has suffered brain damage from overventilation include:

• Abnormal blue skin tone
• Very low heart rate
• Weak reflexes or lack of muscle tone
• Seizures and other neurologic issues
• Organ malfunction

If brain injury from overventilation is suspected, there are variety of medical imaging tests that can be done to confirm the diagnosis and assess the damage. These tests include:

• CT Scan
• MRI
• Blood tests
• EKG

Real-World Scenarios: When Neonatal Overventilation Happens

Parents often learn the term overventilation in the most harrowing way—when their newborn is placed on a ventilator in the NICU and begins showing signs of neurologic distress. The baby may appear to be breathing too fast or too deeply, resembling baby hyperventilating. While it can look like panic breathing, in infants it often signals improper ventilator settings or excessive manual use of a bag-valve mask.

In NICU settings, newborns on ventilators are at real risk when care teams fail to closely monitor oxygen levels and blood gases. Overventilation can lead to a sharp drop in carbon dioxide, triggering hypocarbia, a condition that restricts blood flow to the brain. This is especially dangerous in the first hours of life or when infants on ventilators remain mechanically supported for an extended period. The damage can happen quietly, with no outward signs, particularly in premature infants whose lungs are still developing.

Some babies are placed on a ventilator immediately after birth due to respiratory distress. When a baby is on a ventilator after birth and begins to deteriorate neurologically, the underlying cause may not be lung failure but rather poor ventilation technique. Excessive bagging or improperly set automated ventilators can lead to overventilation and falling CO₂ levels.

These injuries become more likely when NICU staff fail to adjust ventilator settings based on blood gas analysis. Without proper interpretation of ventilator data and timely interventions, complications like pneumothorax, bronchopulmonary dysplasia, or periventricular leukomalacia can occur. In many of these cases, the infant was simply overventilated, and the problem was not corrected before lasting damage occurred.

Overventilation is especially dangerous when too much air or pressure is used during resuscitation or ongoing support. Improper technique and poor oversight can cause carbon dioxide to drop to unsafe levels, even in a matter of minutes. The consequences of infant hyperventilating during critical care are often permanent and avoidable.

When a newborn requires breathing support, the use of force or high pressure during ventilation must be carefully controlled. Using too much force when ventilating a child can lead to serious internal injuries and long-term neurological damage… often without any visible warning signs until it is too late.

If your child was placed on a ventilator and later diagnosed with brain damage, cerebral palsy, or suffered unexplained seizures, it may be the result of neonatal overventilation and hypocarbia. These are not just tragic outcomes. They are preventable medical errors.

Medical Malpractice Claims for Overventilation Injuries

Brain damage from overventilation of a newborn does not just happen on its own. Overventilation of a newborn ONLY occurs when the doctors or nurses are negligent in some way. Failure to recognize and correct neonatal overventilation is medical negligence. If this results in serious injury to the baby, the doctors, nurses, and hospital can be liable for medical malpractice.

If you suspect that your baby was overventilated and suffered a major brain injury as a result, you need to consult with experienced birth injury lawyers. A birth injury lawyer can obtain the relevant medical records and have them reviewed by qualified experts to det
ermine whether your baby was overventilated. They can also help you get financial compensation to cover the cost of your baby’s medical care for the remainder of their life.

 FAQs: Over-Ventilation in Newborns