Apgar Score

The Apgar Score, developed in 1952 by an anaesthesiologist called Victoria Apgar, is a quick check designed to determine the physical condition of a newborn baby immediately after birth.

The test is carried out by a doctor, midwife or nurse in the delivery room usually on two occasions: one minute after birth and then again five minutes after birth. Sometimes, if there are concerns about the baby's condition or the score at five minutes is low, the test may be taken for a third time 10 minutes after birth.

It is called the Apgar Score because it checks for Appearance (skin colouration), Pulse, Grimace (responsiveness), Activity (muscle tone), and Respiration (breathing rate and effort).

The scoring system

Each of the criteria is given a score of 0, 1 or 2 and then added together to generate a total score out of 10, which gives an idea of the overall health of the baby.

The scoring system works as follows:

Appearance:

• Normal colour all over (hands and feet are pink) = 2 points
• Normal colour (but hands and feet are blue-ish) = 1 point
• Blue-ish-grey or pale all over = 0 points

Pulse:

• Normal (above 100 beats per minute) = 2 points
• Below 100 beats per minute = 1 point
• Absent (no pulse) = 0 points
• Grimace (responsiveness or ‘reflex irritability’):
• Pulls away, sneezes, coughs or cries with stimulation = 2 points
• Facial movement only (grimace) with stimulation = 1 point
• Absent (no response to stimulation = 0 points

Activity:

• Active, spontaneous movement = 2 points
• Arms and legs flexed with little movement = 1 point
• No movement - ‘floppy’ muscle tone = 0 points
• Respiration:
• Normal rate and effort, good cry = 2 points
• Slow or irregular breathing, weak cry = 1 point
• Absent (no breathing) = 0 points

The majority of newborns are scored between seven and 10, meaning they do not require any immediate treatment. Scores of 10 are unusual, because most newborns will lose a point for having blue hands and feet, which is typical after birth.

Scores lower than seven suggests the baby needs medical attention, and if the score remains low after multiple tests, then there is a risk that the child will suffer longer-term neurological damage.

Erb's Palsy

This condition is usually caused by a traumatic childbirth where the baby's arm is paralysed when the upper group of the arm's main nerves is injured.

Erb's Palsy, or otherwise known as brachial plexus paralysis, can occur if the infant's head and neck are pulled toward the side at the same time as the shoulders pass through the birth canal.

The condition can also be caused by excessive pulling on the shoulders during a cephalic presentation (head first delivery), or by pressure on the raised arms during a breech (feet first) delivery.

Other causes can include a raised BMI of the mother at time of baby's birth, a high weight at birth and a long second stage of labour.

The child is usually unable to abduct the arm from the shoulder, rotate the arm externally from the shoulder or supinate the forearm giving them a 'waiter's tip' appearance.

Hand grasp in children with Erb's Palsy is usually normal unless the lower part of the plexus is also damaged.

Some babies recover on their own but some need specialist treatment.

Emergency Caesarean Section

This procedure is usually carried out when a normal vaginal delivery would put the mother or the baby at risk.

However, an emergency caesarean is performed when circumstances before or during labour call for an unplanned procedure.

A caesarean section is usually carried out under an epidural or a spinal anaesthetic causing the lower part of the body to be numbed. The procedure usually takes 40-45 minutes but, during an emergency, can be performed quicker.

The risks to the mother in a caesarean section can include an infection of the wound or the womb lining, a blood clot (thrombosis) in the legs or excess bleeding.

Doctors now give the mother a dose of antibiotics before the operation to reduce the likelihood of any infections.

Risks to the baby during a caesarean, according to the NHS, are no greater than a normal vaginal delivery but the most common problem of babies delivered by caesarean is difficulty breathing, although this usually affects babies born prematurely.

Hypoxic-Ischemic Encephalopathy (HIE)

This brain injury occurs in newborn babies and is caused by oxygen deprivation to the brain, also known as intrapartum asphyxia.

Although a newborn's body can manage for brief periods of time with reduced oxygen, if it lasts too long then the brain tissue is destroyed.

Hypoxic-ischemic encephalopathy due to fetal or neonatal asphyxia is a leading cause of death or severe impairment among infants.

Effects of this brain injury can include delays in neuro-development, cognitive impairment and epilepsy; the area of the brain injury can depend on the timing and severity of the asphyxia.

MRI scans are usually performed once hypoxic-ischemic encephalopathy is suspected to aid diagnosis.

Although there is no definite cure for HIE. any treatment includes helping the child adapt to symptoms of the brain injury and physical and occupational therapy is commonly used.