Abstract
M.S. was delivered at 40 weeks by emergent caesarian section after late decelerations were noted on exam. Her Apgar scores were 8 and 9 at one and 5 min, respectively. Although she had difficulty sucking a bottle, she was released from the hospital without neurological consultation. She went on to develop persistent physical and mental disabilities, including generalized hypotonia, impaired language development, and severe ADHD. The patient’s symptoms were never definitively linked to perinatal distress, and the possibility of hypoxic-ischemic encephalopathy was not investigated. Her parents, deeply distressed by their lack of answers, brought her to our clinic as an 18- year-old. We ordered DW-MRI and found evidence of remote hypoxia. Paired with the clinical history, these findings suggest the patient suffered HIE due to fetal distress. This case demonstrates that overreliance on the Apgar score can lead clinicians to miss abnormalities in the critical window of early infancy and fail to connect later pathologies with birth trauma.
Highlights
First developed by pediatric anesthesiologist Virginia Apgar in 1952, the Apgar score has become a standard for assessment of the newborn [1]
Given the patient’s history of a complicated delivery and motor and cognitive deficits dating to birth, we considered that her disability could be the result of hypoxic-ischemic encephalopathy (HIE)
Given that up to 20% of birth asphyxia cases may be missed on Apgar screening, practitioners providing follow-up care must consider HIE even in infants whose Apgar scores were normal
Summary
First developed by pediatric anesthesiologist Virginia Apgar in 1952, the Apgar score has become a standard for assessment of the newborn [1]. Given the patient’s history of a complicated delivery and motor and cognitive deficits dating to birth, we considered that her disability could be the result of hypoxic-ischemic encephalopathy (HIE). This condition is usually identified in infants and is almost always associated with a low Apgar score. M.S. most likely suffered HIES due to perinatal distress Her parents were informed of this probable diagnosis as well as the fact that her condition would likely require lifelong medical care, motor and cognitive therapy, and continuous supervision
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