don't understand something

Specialties NICU

Published

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.

Specializes in NICU.
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...

Specializes in NICU.

It's 15 minutes IIRC (it's been a while since I opened my NRP instructor book, darn you maternity leave I'm all rusty!)

We recently had a shoulder dystocia who's Apgars were 0,0 and 7 had some encephalopathy but went home in a week, nipplingm doing fine but scheduled for high risk follow up. (Yes, I realize an Apgar of 7 is very different than a 1)

The OP's kiddo had a lot wrong in his world poor guy :(

Another thing to consider is if there were good heart tones documented right before delivery. As opposed to not being able to get any or very poor ones.

Specializes in NICU.
Another thing to consider is if there were good heart tones documented right before delivery. As opposed to not being able to get any or very poor ones.

Good point. I believe this one reason why preemies do better during resuscitation than full term babies that are sectioned for distress. The preemies are often doing just fine until that cord is cut, then they're out of luck because their bodies are just not equipt to survive on their own yet. Once we warm them and get an airway, they usually respond nicely. But a big full term kid who has been having decels, is stuck, heart tones are poor, etc. is already depressed at birth. Much harder to resuscitate a body that has already gone without oxygen for a while.

Specializes in Community, OB, Nursery.
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.

Amen! If I had a nickel for every time I have a mom of a 26-weeker (and in our hospital more often than not she's addicted to at least 1 substance) says, "Oh, she's fine" about her NICU baby, I'd be able to quit my job.

No, your baby is not fine. She is fighting like a mad dog to live despite the cocaine (or nicotine, or alcohol, pick your substance) you flooded her with for 26 weeks.

Specializes in NICU.
Amen! If I had a nickel for every time I have a mom of a 26-weeker (and in our hospital more often than not she's addicted to at least 1 substance) says, "Oh, she's fine" about her NICU baby, I'd be able to quit my job.

No, your baby is not fine. She is fighting like a mad dog to live despite the cocaine (or nicotine, or alcohol, pick your substance) you flooded her with for 26 weeks.

No kidding. Or when that same crack-addicted mom thinks it's so cruel that we have to keep "sticking" the baby for IVs or labs .... and the "poor thing is hooked up to all this stuff". Um well yeah. Yeah God forbid we have to stick the baby for an IV, but the crack she did throughout the pregnancy was OK.

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