Low apgar long term

[orzo15]

My baby was born a few weeks ago, he came out blue and though had an ok apgar at 1 min, he then struggled to breath and didn't pink up, was whisked away while they checked his cord gases (which were ok), and had an apgar of 6 at 5 mins. He was then taken to nicu on cpap, which we were in for 2 nights.

It was a shock after uncomplicated labour, and i am really struggling with worrying about his future and the long term effects. Have read many things about low 5 min apgar score and problems in later life. He also had jaundice and needed light therapy which also seems linked to problems so am so worried about whether these will have affected his brain health.

Can anyone who had a baby with lower apgar scores share if their child was affected long term?

I'm assuming he has now been discharged from hospital and they are happy he has no underlying issues?? Hearing test all good, reflexes etc?

My daughter was an elective section, had TTN and didn't take her first breath for 3 minutes (so it says in the notes) I can't remember her apgars but they were on the low side, 3 or 4 maybe? Also spent 2 days in NICU on cpap and optiflow.

She is now the most intelligent and chatty 3 year old. So please don't try to worry. As I understand some babies just take a little bit longer to get used to the outside world, and a score of 6 is classed as 'moderately abnormal' rather than low. So try not to worry. X

Thank you so much for your reply, that's so reassuring to hear. They seemed happy with him and happy enough to discharge, it's definitely me that's worrying more than I should.

I think that is actually what my son had TTN. They never said that to me but I'm in a different country so maybe they used different name, but they said because he was born very quickly his lungs didn't properly inflate and he had fluid on them and so needed cpap to help open them up fully. Did you worry after you were sent home or able to put it behind you? X

That sounds exactly the same as what my daughter had. To be honest I do remember being anxious when she was first brought home but i chalk that up now to post partum anxiety and the massive hormonal changes you have after birth. Do you think you might be suffering from this a bit? If your little one seems happy and is reacting to your voice, feeding well etc, you really can't wish for more at a few weeks old. Enjoy it and definitely talk to someone if you feel the worry is getting too much xx

This is quite a common scenario. Just going from what you have said, if it was my baby, I would not feel concerned about their long term neurodevelopment - I would fully expect it to be normal.

Obviously disclaimer I do not have the full details and have not assessed your baby! But just going from you have said.

Just for more information - The context of a low 5 minute APGAR potentially being linked to a worse neurological outcome is generally in babies who also had a low 1 minute APGAR, due to birth asphyxia (lack of oxygen before or during delivery). To still have a low APGAR score at 5 minutes despite resuscitation is in general, more suggestive of a severe/persistent period of asphyxia with more associated brain injury. But the context in your baby, of having a post-birth respiratory problem such as TTN, is very different, and just doesn't have the same causal link to brain injury at all. Your baby is likely to have been well oxygenated soon after they began to get into difficulty, due to appropriate respiratory support they were given. If that helps to explain it a bit.

Pretty much the same as my son who is now 24. Worst thing was he's mixed race and when his Apgar was low they decided it was a faulty monitor and his (I later realised) unhealthy colour was because he was mixed race!!! It took them about another half hour until they stepped in and took him to SCBU where he stayed for 4 days and I saw what a healthy colour was. Also he then got jaundice! We were in hospital for 6 days. They wanted to keep us longer because of the jaundice but they let me go home as long as I promised to return the following day to check his bilirubin levels.

It has not affected him in the slightest. At 24 he's happy and healthy with no issues whatsover. He's, intelligent, went to UNI and got a 2:1 degree so no it's not affected him adversely at all.

If it helps your anxiety, can I point out that you don’t know he had a very low apgar for 5 minutes. In fact you know he didn’t, as at 5 minutes he had a moderate apgar at 6. It is 0-3 which is concerning. So it was probably only very low for a minute or so as he was then dealt with very promptly. And that is extremely common and most unlikely to cause any issues at all. Just try to enjoy the gorgeous boy! Congrats!

Thank you so much for your replies it helps so much. @KidsDr that is so reassuring thank you for adding that, it makes sense because I had only read about those whose apgar scores improved rather than got worse. His was a 9 at one minute and then he struggled with breathing because of the fluid, so that's so reassuring that it's related to persistent deprivation of oxygen which he didn't have.

I'm sure definitely my postpartum hormones are not helping my anxiety about this! I will really try not to google now and enjoy my baby boy, thank you x

just gone back and checked, dd was apgar 5 at 1 minute post birth and apgar 7 at 5 mins post.

she was born floppy and not breathing independently. Was on a cpap and went to NICU for 2 days.

j was wondered for ages about developmental issues but she’s almost 2 and seems completely fine to me :) she seems in line with my first baby

@Rumblytumblytea Thank you so much, i am feeling so much better about it now i can see him hitting milestones :)

I’m a midwife.

The APGAR score is used to assess the neonatal transition to extrauterine life and determine which babies need resuscitation / additional support. It has no predictive ability for long term outcomes.

Extensive resuscitation can lead to poorer longer term outcomes due to the resulting hypoxia and these babies would also have a low APGAR but it’s the lack of oxygen to the brain that’s the issue and this is the case with any prolonged resuscitation regardless of APGAR scores.

Besides that an APGAR of 6 is moderate and wouldn’t give me cause for concern, considering an APGAR of 7 is normal. Some babies just take a bit longer to perfuse.