If your baby has been diagnosed with cerebral palsy and you suspect it may have been caused by medical negligence, a careful examination of the neuroimaging, the neonatal records, and the electronic fetal monitor tracing can indicate whether your child likely suffered a birth injury during labour and delivery.
This is the only legal guide in Canada written specifically for parents of children injured during childbirth. The book is available to download on our website for free. If you would like a print copy, the book is for sale on Amazon all proceeds go to charity , but we will send you a copy at no charge , if you call us, toll-free at BILA What does a 65 year old test have to do with the health of your baby?
Five criteria There are five categories, or criteria, that the nurse or physician must consider and assign a value. Fetal surveillance in labor. Munro Kerr's Operative Obstetrics. Philadelphia, PA: Elsevier; chap 9. Goyal NK. The newborn infant. In: Kliegman RM, St. Nelson Textbook of Pediatrics.
Philadelphia, PA: Elsevier; chap Updated by: Neil K. Editorial team. Apgar score. In rare cases, the test will be done 10 minutes after birth. Virginia Apgar, MD introduced the Apgar score in How the Test is Performed. The Apgar test is done by a doctor, midwife, or nurse. The provider examines the baby's: Breathing effort Heart rate Muscle tone Reflexes Skin color Each category is scored with 0, 1, or 2, depending on the observed condition.
Breathing effort: If the infant is not breathing, the respiratory score is 0. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists encourage use of an expanded Apgar score reporting form that accounts for concurrent resuscitative interventions. In , Dr. Virginia Apgar devised a scoring system that was a rapid method of assessing the clinical status of the newborn infant at 1 minute of age and the need for prompt intervention to establish breathing 1.
A second report evaluating a larger number of patients was published in 2. This scoring system provided a standardized assessment for infants after delivery. The Apgar score comprises five components: 1 color, 2 heart rate, 3 reflexes, 4 muscle tone, and 5 respiration, each of which is given a score of 0, 1, or 2.
Thus, the Apgar score quantitates clinical signs of neonatal depression such as cyanosis or pallor, bradycardia, depressed reflex response to stimulation, hypotonia, and apnea or gasping respirations. The score is reported at 1 minute and 5 minutes after birth for all infants, and at 5-minute intervals thereafter until 20 minutes for infants with a score less than 7 3.
The Apgar score provides an accepted and convenient method for reporting the status of the newborn infant immediately after birth and the response to resuscitation if needed; however, it has been inappropriately used to predict individual adverse neurologic outcome. The purpose of this statement is to place the Apgar score in its proper perspective. However, resuscitation must be initiated before the 1-minute score is assigned.
Therefore, the Apgar score is not used to determine the need for initial resuscitation, what resuscitation steps are necessary, or when to use them 3. An Apgar score that remains 0 beyond 10 minutes of age may, however, be useful in determining whether continued resuscitative efforts are indicated because very few infants with an Apgar score of 0 at 10 minutes have been reported to survive with a normal neurologic outcome 3 4 5.
Neonatal Encephalopathy and Neurologic Outcome , Second Edition, published in by the College in collaboration with the AAP, defines a 5-minute Apgar score of 7—10 as reassuring, a score of 4—6 as moderately abnormal, and a score of 0—3 as low in the term infant and late-preterm infant 6.
However, a persistently low Apgar score alone is not a specific indicator for intrapartum compromise. Further, although the score is used widely in outcome studies, its inappropriate use has led to an erroneous definition of asphyxia.
Asphyxia is defined as the marked impairment of gas exchange leading, if prolonged, to progressive hypoxemia, hypercapnia, and significant metabolic acidosis. The term asphyxia, which describes a process of varying severity and duration rather than an end point, should not be applied to birth events unless specific evidence of markedly impaired intrapartum or immediate postnatal gas exchange can be documented based on laboratory testing 6.
It is important to recognize the limitations of the Apgar score. There are numerous factors that can influence the Apgar score, including maternal sedation or anesthesia, congenital malformations, gestational age, trauma, and interobserver variability 6.
In addition, the biochemical disturbance must be significant before the score is affected. Elements of the score such as tone, color, and reflex irritability can be subjective, and partially depend on the physiologic maturity of the infant. The score also may be affected by variations in normal transition. The healthy preterm infant with no evidence of asphyxia may receive a low score only because of immaturity 7 8.
The incidence of low Apgar scores is inversely related to birth weight, and a low score cannot predict morbidity or mortality for any individual infant 8 9. As previously stated, it also is inappropriate to use an Apgar score alone to diagnose asphyxia. The 5-minute Apgar score, and particularly a change in the score between 1 minute and 5 minutes, is a useful index of the response to resuscitation.
If the Apgar score is less than 7 at 5 minutes, the Neonatal Resuscitation Program guidelines state that the assessment should be repeated every 5 minutes for up to 20 minutes 3. However, an Apgar score assigned during a resuscitation is not equivalent to a score assigned to a spontaneously breathing infant There is no accepted standard for reporting an Apgar score in infants undergoing resuscitation after birth because many of the elements contributing to the score are altered by resuscitation.
The concept of an assisted score that accounts for resuscitative interventions has been suggested, but the predictive reliability has not been studied.
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