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 setup 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 breath 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 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 which either assist the newborn with breathing or completely breath for them. Mechanical ventilators have displays which 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 may misinterpret or overact 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 oxygen or CO2, which creates a risk of overventilation.
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.
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
- Blood tests
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 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 determine 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.Overventilation Verdicts & Settlements
- Mendez v. N.Y. Presb. Hosp. (New York 2019) $3,500,000 Verdict: infant born prematurely (25 week) and required emergency respiratory assistance at birth. Doctors allegedly caused injury to the newborn's brain from overventilation by attempting positive pressure ventilation for too long instead of mechanical ventilator. Defense argued that the infant's injuries were due entirely to her prematurity. NYC jury awarded $3.5 million in damages.
- Reyes v. Brownsville Pediatric (Texas 2007) $8,000,000 Verdict: infant was over-ventilated for over 48 hours resulting in acid buildup and acute decrease in carbon dioxide levels in infant's blood. This caused decrease blow flow to the brain caused permanent brain damage and blindness. Jury awarded $8 million.
- Parents v Roe Neonatologist (California 2004) $165,000 Verdict: plaintiffs alleged that defendant neonatologist over-ventilated their newborn infant, thereby causing a severe pneumothorax injury and then failing to timely diagnose and treat that injury. The infant eventually died as a result of the injuries. Defendant claimed that the infant's pneumothorax developed on its own and was not caused by his over ventilation.
Over-ventilation in a newborn baby occurs when a neonatal breathing device (i.e., a mechanical ventilator or bag ventilator) gives the baby too much air. This causes CO2 levels in the baby's bloodstream to drop too low (a condition called hypocarbia) which can restrict cerebral blood flow and cause brain damage.
Babies that are born prematurely or with other complications may have difficulty breathing on their own. Newborns with respiratory difficulties will be put on a ventilator to help ensure that they get enough oxygen until they are able to breath independently.
If a baby is not breathing normally when they are first born, doctors must take immediate steps to resuscitate them. Neonatal emergency resuscitation usually involves manually clearing the baby's airways, then administering positive air pressure, often with a bag ventilator.
The first signs of respiratory distress in a newborn include physical indications of labored breathing (flared nasals, chest heaving, grunting, etc.). Abnormal skin coloring can also be an indication of breathing difficulty. Doctors will also measure the baby's respiratory rate. A normal rate is 30 to 60 breaths per minute.
A pneumothorax is an internal injury to the lungs that occurs when a mechanical ventilator creates too much air pressure in the lungs causing the tiny air sacs in the lung (alveoli) to burst.
If you believe your child suffered a birth injury due to medical negligence, contact the Maryland birth injury lawyers at Miller & Zois for a free consultation.