A pediatrician was called to the hospital to attend the delivery
of a newborn. The mother, a 28-year-old primigravida, had experienced
elevated blood pressure during an otherwise uncomplicated pregnancy.
The labor was induced because the pregnancy had continued 2 weeks
past the expected date of delivery. During labor, evidence of fetal
distress was seen. When the membranes ruptured, the obstetrician
noted thick greenish fluid containing meconium. At the time of delivery, the
male newborn was limp and cyanotic, and had no spontaneous respiratory
effort and a heart rate of only 50 beats/minute. When meconium
was suctioned from his mouth and nose, the baby did not grimace,
cough, or sneeze.
Vigorous efforts at resuscitation were initiated, including bag-and-mask
ventilation with 100% oxygen and chest compressions, but
the Apgar score at 1 minute of life was 1. The Apgar score (Table
8–1), an index of neonatal asphyxia, can range from 0 (very
asphyxiated) to 10 (no asphyxia). Despite continuing resuscitation,
the 5-minute Apgar score improved only to 2, with a heart rate of
110 beats/minute. The 10-minute Apgar score remained depressed
at 3, and the neonate was transferred to the newborn intensive care
unit. With aggressive medical management, the 3100-g neonate continued
to improve without evidence of acute neurologic complications. He was
discharged from the hospital on the twelfth day of life.
Table 8–1. Apgar
Score for Evaluation of Neonatal Asphyxia.a |Favorite Table|Download (.pdf)
Table 8–1. Apgar
Score for Evaluation of Neonatal Asphyxia.a
|Heart rate (beats/min)||Absent||< 100||> 100|
|Respiration||Absent||Slow, irregular||Regular, crying|
|Muscle tone||Limp||Slow flexion||Active motor|
|Color||Blue, pale||Body pink, extremities blue||Completely pink|
|Reflex response to catheter in nostril||None||Grimace||Cough, Sneeze|
Perinatal asphyxia can be defined ...