don't understand something

  1. I have a question about the Apgar Score. When a baby scores 0 on an Apgar at birth, what is protocol? I thought 0 meant the baby was dead? I had a patient today, according to his admission history he scored 0,0,0,1 on his Apgars. His mother was homeless, and presented to the ER in DKA and had previously tested positive for Cocaine, ETOH, and marijuana during her pregnancy (tested negative at delivery). They delivered this baby via emergency csection because of decels (late? I need to brush up on my OB). The baby is 2 months old.

    I am honestly perplexed. This child has no gag reflex, his eyes don't track and he tremors constantly. He has also suffered from a brain bleed. I just wondered exactly what the Apgar tells you.
    Last edit by Imafloat on Oct 27, '06
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  2. 17 Comments

  3. by   BSNtobe2009
    Please tell me they are not letting her leave the hospital with that baby
  4. by   Imafloat
    Quote from BSNtobe2009
    Please tell me they are not letting her leave the hospital with that baby
    No, Child Protective Services has temporary custody, the baby will go to a foster home.
  5. by   BSNtobe2009
    Thank God.

    Call me heartless, but I just have absolutely no sympathy for people that are drug addicts and have babies. I feel that people choose to be addicts...don't take the drugs in the first place and you never have to worry about being an addict!
  6. by   Melina
    Apgar score is usually taken at 1 and 5 minutes, and every 5-10 minutes after if the score is low (I suppose this could vary hospital to hospital). I could see the first one at 0, I guess, but four in a row?

    ~Mel'
  7. by   Dieselmota
    An APGAR score of 0 indicates that the baby is in need of immediate resuscitation.

    7-10 normal
    4-7 some resuscitative measures
    <3 immediate resuscitation
    Last edit by Dieselmota on Oct 28, '06
  8. by   Gompers
    http://en.wikipedia.org/wiki/Apgar_score

    Apgars of 0-0-0-1 basically means that at 1, 5, and 10 minutes the baby was, for all intents and purposes, dead. At 15 minutes they assigned a score of 1. Some hospitals will stop coding at 10 minutes, others at 15. Probably what happened was they were doing total resuscitation for the full 15 minutes and at that point got the baby's heart to beat on it's own. Now, a score of 1 means that the heart rate still would have been under 100, but if it was beating on it's own then the baby was indeed alive at that point.

    I have never seen a baby with an apgar of 0 past 5 minutes do very well. For babies who still have an apgar of <3 at 15 minutes, I've never seen them survive without devastating brain damage.
    Last edit by Gompers on Oct 28, '06
  9. by   Imafloat
    Quote from Gompers
    http://en.wikipedia.org/wiki/Apgar_score

    Apgars of 0-0-0-1 basically means that at 1, 5, and 10 minutes the baby was, for all intents and purposes, dead. At 15 minutes they assigned a score of 1. Some hospitals will stop coding at 10 minutes, others at 15. Probably what happened was they were doing total resuscitation for the full 15 minutes and at that point got the baby's heart to beat on it's own. Now, a score of 1 means that the heart rate still would have been under 100, but if it was beating on it's own then the baby was indeed alive at that point.

    I have never seen a baby with an apgar of 0 past 5 minutes do very well. For babies who still have an apgar of <3 at 15 minutes, I've never seen them survive without devastating brain damage.
    Thank you for this explanation. I know what an Apgar is and what it means, but I just didn't understand the resuscitation for 15 minutes part. We were busy yesterday and I never had time to sit down with my preceptor and ask her about this.
  10. by   babynurselsa
    This baby evidentally had a prolonged resusitation. You can pretty much count on signifigant brain damage, severe cp. THough sometimes the little buggers will suprise you.
    I had a baby several years ago with pretty much the same apgars. Mom had abrupted, srash section,etc. But by the time she was a couple of weeks old she acted completely appropriately for a term NB. Now I would like to se her today and see how she is.
    One thing that can be very heartening about NICU is that babies can sometimes have this remarkable capacity to get better. The flip side of that is those stories get out and people do not realize that these are the EXCEPTION to the rule and think this happens in every case. You just never know.
  11. by   Jolie
    Another important thing to consider is that it is never appropriate to wait for the 1 minute apgar to begin resuscitation efforts. So as Gompers pointed out, the child scored a 0 at 1,5 and 10 minutes of age, despite ongoing resuscitation. That may indicate that the "insult" experienced by the baby was not limited to the immediate pre-delivery period. This poor child was probably compromised by drugs, alcohol, improper acid-base balance, and lack of oxygen for a long period of time prior to delivery.

    While newborn infants sometimes make remarkable recoveries from traumatic deliveries, I believe it is highly unlikely that this child will, due to the likelihood that his insult was long-term, and did not occur solely in the period of time immediately prior to delivery.
  12. by   Gompers
    Quote from Jolie
    Another important thing to consider is that it is never appropriate to wait for the 1 minute apgar to begin resuscitation efforts. So as Gompers pointed out, the child scored a 0 at 1,5 and 10 minutes of age, despite ongoing resuscitation. That may indicate that the "insult" experienced by the baby was not limited to the immediate pre-delivery period. This poor child was probably compromised by drugs, alcohol, improper acid-base balance, and lack of oxygen for a long period of time prior to delivery.

    While newborn infants sometimes make remarkable recoveries from traumatic deliveries, I believe it is highly unlikely that this child will, due to the likelihood that his insult was long-term, and did not occur solely in the period of time immediately prior to delivery.
    Very good points! Yes, if a baby continues to have very low Apgars beyond 5 minutes, it's usually a sign that the baby was already compromised in utero. The main reason babies don't do well at birth is respiratory arrest - so in theory, once you get the baby intubated the Apgars should significantly improve because you now are breathing for it. This is why micropreemies often have very low 1 minute Apgars (since they are not ready to instinctively take a breath and cry at birth, and because their lack of body fat causes them to freeze very quickly) but by 5 minutes if they have been kept warm and have been intubated, they are often doing great. These kids are often doing okay up until the moment they're born, so their bodies aren't as compromised and they respond nicely to resuscitation.

    Now, if a baby is doing poorly in utero (decels, abruption, preeclampsia, meconium, cord compression, etc.) then when they are born, their bodies are already fighting a battle so they don't come around as nicely since there is more going on with them than respiratory depression. Ask anyone who is NRP certified and attends deliveries - it's usually much easier to resuscitate a 24-weeker than a full-term baby if the initial Apgar is 0 or 1.
  13. by   dawngloves
    Am I wrong or do new NRP guidlines suggest to discontinue resuitive efforts at a delivery like this after 10 minutes?
  14. by   Gompers
    Quote from dawngloves
    Am I wrong or do new NRP guidlines suggest to discontinue resuitive efforts at a delivery like this after 10 minutes?
    I think they've always recommended 10 minutes but for some reason many people will continue for 15. I don't think they're doing anyone any favors after 10 minutes so I really wish it was more than a recommendation - I wish it was some kind of hard and fast rule...

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