When a baby is born, the doctor or midwife examines the newborn for any obvious abnormalities or signs of distress. The newborn's condition immediately after birth is recorded at 1 minute and at 5 minutes after birth using the Apgar score. The Apgar score is used to assign points for heart rate, effort to breathe, muscle tone, reflexes, and color. A score of 7 to 10 is considered normal, 4 to 6 is intermediate, and 0 to 3 is low. A low Apgar score is a sign that the newborn is having difficulty and may need extra assistance with breathing or blood circulation. The Apgar score does not predict anything about the baby's health after the first few minutes of life.
Color of skin
All blue, pale
Pink body, blue hands and feet
Less than 100 beats per minute
More than 100 beats per minute
Reflex response to stimulation of the nose (by touching it with a finger or a catheter)
No response to stimulation
Limp, no movement
Some bending of arms and legs
* The word "Apgar" is also an acronym. The letters A, P, G, A, and R correspond to the bold letters in this column.
† The baby is given a score from 0 to 2 for each of 5 characteristics. A total score of 7 to 10 at 5 minutes is considered normal, 4 to 6 is intermediate, and 0 to 3 is low.
Babies with a low Apgar score may be having trouble with breathing or blood flow. Birth asphyxia (also called perinatal asphyxia) is a decrease in blood flow to the newborn's tissues or a decrease in oxygen in the newborn's blood before, during, or just after delivery. Some potential causes include the following:
Separation of the placenta from the uterus before delivery (placental abruption Placental Abruption Placental abruption is the premature detachment of the placenta from the wall of the uterus, usually after 20 weeks of pregnancy. Women may have abdominal pain and tenderness and vaginal bleeding... read more )
Obstruction of umbilical cord blood flow
Abnormal development of the fetus (for example, when there is a genetic anomaly)
Severe infection in the fetus
Exposure to certain drugs or medications before birth
Severe maternal hemorrhage
Severe maternal illness
Sometimes the exact cause of birth asphyxia cannot be identified.
Regardless of the cause, affected newborns appear pale and lifeless at birth. They breathe weakly or not at all and have a very slow heart rate. The doctors and nurses provide care to revive (resuscitate) the newborn. Resuscitation may include use of a resuscitation bag and mask to push air into the lungs or insertion of a breathing tube in the newborn's throat (endotracheal intubation). If asphyxia resulted from rapid blood loss, the newborn may be in shock Shock Shock is a life-threatening condition in which blood flow to the organs is low, decreasing delivery of oxygen and thus causing organ damage and sometimes death. Blood pressure is usually low... read more . They are immediately given fluids by vein, and sometimes a blood transfusion Overview of Blood Transfusion A blood transfusion is the transfer of blood or a blood component from one healthy person (a donor) to a sick person (a recipient). Transfusions are given to increase the blood's ability to... read more or plasma.
Newborns may require care in the neonatal intensive care unit (NICU Neonatal intensive care unit (NICU) Problems in newborns may develop Before birth while the fetus is growing During labor and delivery After birth About 10% of newborns need some special care after birth due to prematurity, problems... read more ).
Newborns with asphyxia may show signs of injury to one or more organ systems, including the following:
Heart: Poor color, low blood pressure
Lungs: Difficulty breathing and low oxygen levels
Brain: Lethargy, seizures, or even coma
Kidneys: Reduced output of urine
Liver: Difficulty making proteins that are needed for blood to clot normally
Intestines: Difficulty digesting milk
Blood forming system: Low platelet count and bleeding
Newborns may need medications to help their heart function and a mechanical ventilator Mechanical Ventilation Mechanical ventilation is use of a machine to aid the movement of air into and out of the lungs. Some people with respiratory failure need a mechanical ventilator (a machine that helps air get... read more to support their breathing.
Most of the organs damaged by birth asphyxia recover over a week, but brain damage may persist in some infants. Infants who have no or minimal injury to the brain may have no ongoing health problems. Those who have moderate to severe injury to the brain may have permanent developmental issues, ranging from mild learning disorders Learning Disorders Learning disorders involve an inability to acquire, retain, or broadly use specific skills or information, resulting from deficiencies in attention, memory, or reasoning and affecting academic... read more to delayed development to cerebral palsy Cerebral Palsy (CP) Cerebral palsy refers to a group of conditions that involve difficulty moving and muscle stiffness (spasticity). It results from brain malformations that occur before birth as the brain is developing... read more . Some infants with severe asphyxia infants do not survive.