Can Low Apgar Scores Be an Indication of Cerebral Palsy?
Healthcare professionals evaluate newborn babies, grading them with Apgar scores, an assessment that analyzes their appearance, responsiveness and general condition shortly after birth. In this article, we take a closer look at the connection between low Apgar scores and cerebral palsy.
What Is an Apgar Score?
The Apgar score—developed in 1952 by Dr. Virginia Apgar—is a number, given to newborn babies by medical professionals, at one and five minutes of life. After assessing the newborn, a score between 0 and 10 will be assigned. This score reflects the baby’s well-being immediately after birth and while transitioning to life outside of mom. If a newborn has difficulty or needs help transitioning, Apgar scores may continue in five minute increments up to 20 minutes after birth.
The Apgar score has five categories. Babies get a grade of 0, 1, or 2 in each category. The total of these is the final score. The categories are:
- Appearance (skin color)
- Pulse rate
- Grimace (reflexes, or the baby’s reaction to stimulation, such as a mild pinch)
- Activity (muscle tone)
- Respiratory effort (breathing)
Healthcare professionals give babies an Apgar score one minute after birth. This initial score indicates how well they handled their birth. They give a further Apgar rating five minutes after birth. This second score shows how well the baby is responding to life outside the womb. Health workers may give a third Apgar score 10 minutes after birth, especially if previous scores are low.
The American Academy of Pediatricians notes that most newborn babies have an initial Apgar score greater than 7. Usually, healthcare professionals can take action and improve a baby’s health for a better score at the five-minute mark. Consistent low Apgar scores show babies need more intensive medical intervention to thrive.
The Link Between Cerebral Palsy and Low Apgar Scores
The National Institute for Neurological Disorders and Stroke states low Apgar scores 10 to 20 minutes after birth may trigger a range of health complications, including cerebral palsy. Further research has strengthened the link between cerebral palsy and low Apgar scores.
The American Academy of Pediatricians notes that initial Apgar scores lower than 7 may indicate problems during birth that lowered oxygen levels in the blood. This is the first sign of a problem that may cause cerebral palsy, as low oxygen in the brain can cause damage.
Usually, healthcare professionals can improve a newborn’s Apgar score by administering oxygen and drying them thoroughly with a towel. However, these efforts are not always fruitful. The longer a baby has low oxygen levels, the greater the risk of damage to their brain.
Low Apgar Scores and Cerebral Palsy Risks for Babies of Different Weights
In his article, “Apgar Scores and Cerebral Palsy,” Athol Kent, of the Department of Obstetrics & Gynaecology, University of Cape Town, states that babies with low Apgar scores at the five-minute assessment had a greater risk of disabilities, such as cerebral palsy, than babies with higher scores. Kent holds a Bachelor of Medicine, Bachelor of Surgery/Chirurgery, Master of Philosophy and Fellow of the Royal College of Obstetricians and Gynecologists, and is a leading authority on neonatal health. He cited a large-scale Norwegian study that found low Apgar scores and cerebral palsy are closely linked in babies of normal birth weight. The link was strongest between low Apgar scores and quadriplegia, a subcategory of spastic cerebral palsy. The research found:
- 0.1% of full-term babies with an Apgar score of 10 were diagnosed with cerebral palsy.
- 10% of full-term babies with an Apgar score of 3 were diagnosed with cerebral palsy.
The study also linked low Apgar scores and cerebral palsy in babies with low birth weights. However, the difference in the figures was not as substantial, as seen here:
- 4% of babies with high Apgar scores and low birth weights were diagnosed with cerebral palsy.
- 17% of babies with low Apgar scores and low birth weights were diagnosed with cerebral palsy.
Small Variations in Apgar Scores Can Be Significant
For years, most research about the link between Apgar scores and cerebral palsy focused on babies with very low scores. However, Swedish research published in The BMJ found even lower scores in the “healthy range” could indicate a greater risk of cerebral palsy. The BMJ, formerly the British Medical Journal, is one of the world’s longest-running peer-reviewed medical journals. The Swedish researchers assessed the five-minute Apgar scores of more than 1.2 million full-term babies born between 1999 and 2012. They found:
- Babies with an Apgar score of 9 were twice as likely to receive a cerebral palsy diagnosis as babies with an Apgar score of 10.
- Babies with an Apgar score of zero were 280 times as likely to receive a cerebral palsy diagnosis as babies with an Apgar score of 10.
Babies with an Apgar score of 7 or 8 at five minutes, then 9 or 10 at 10 minutes were also more likely to receive a cerebral palsy diagnosis than those who scored 9 or 10 both times.
The actions of medical workers during and after your birth can significantly impact your baby’s Apgar score and their likelihood of developing cerebral palsy. If you feel that healthcare provider negligence contributed to your child’s diagnosis, the Cerebral Palsy Family Lawyers at Janet, Janet & Suggs, LLC. are here to help. Complete our online contact form to start uncovering the truth behind your child’s cerebral palsy and seeking the compensation they deserve.