When your new baby arrived after a difficult delivery, the medical team runs all sorts of tests on your newborn and it can be overwhelming. There are numbers being shouted, machines are beeping, the health professionals are exchanging concerned glances and you are left wondering just what in the world is going on. Most parents never thought they would need to learn about blood gases or brain imaging in the first few hours of their babies lives, but knowing what these tests entail will assist you in understanding what your baby will need and why some decisions are being made.
These tests are not the same as those healthy babies normally receive. When deliveries do not go according to plan, doctors need certain information that tells them just how well your baby tolerated the birth so that they can determine what action, if any, is required. The results also help to determine what immediate interventions and future monitoring your newborn may require, and also potential problems that may need addressing. Here is what the most common tests mean and what doctors look for in the results.
APGAR Test: The Quick Initial Test
APGAR tests happen almost instantly after your baby is born and is performed so quickly that you might not even notice that your newborn is being tested. APGAR tests at one minute after birth and then again at five minutes after birth. A nurse or doctor checks your baby’s heart rate, their breathing, muscle tone, reflexes and skin color and gives each of the five checks a score of 0 to 2 with a maximum score of 10.
Normally, healthy new born scores are between 7 to 10. A score of 7 after a minute and 9 after five minutes indicates your newborn is doing well. What the health professionals worry about are low or declining scores. A baby with a score of 3 after one minute needs immediate help and if they do not improve to a score of at least 5 by the five minute mark, this indicates that they are struggling to adapt.
The results after this initial period indicates how well the baby is responding to help after birth. Rising scores indicate that the baby is responding to help whereas a score that is still below 7 (and doctors may even test again after 10 minutes) indicates that the baby may have been deprived of oxygen during birth. The score does not have any real diagnostic merit on its own, but informs the medical team to be on the lookout for potentially related problems.
Most parents are concerned with the one minute score, but five minutes is more important in predicting outcomes after birth. Babies who needed a little bit of extra help but who received assistance afterwards usually have the best outcomes, as opposed to those who are still showing low scores despite any help given to them.
Blood Gas Tests: Oxygen Levels
Blood gas tests check the blood that is drawn from the umbilical cord after birth (sometimes they need to check heel blood or artery blood) and test it for oxygen levels, carbon dioxide, and pH levels. These results show how well your newborn received oxygen during labor and during delivery.
The results depend on the pH level. Normal pH levels of umbilical cord blood is around 7.25 or higher so doctors only start getting concerned once it drops below 7.20. A pH level lower than 7.0 shows severe acidosis which can mean that the baby is not getting oxygen and instead producing lactic acid because its cells cannot function without the oxygen they need.
You might also hear about base deficit (sometimes known as base excess). Base deficit measures the level of metabolic acidosis so worse than -12 base deficit indicates severe deprivation of oxygen, the worse the pH level drops in conjunction with the increased base deficit level indicates how badly the baby was impacted during labor and delivery.
Based on these results doctors make decisions about whether your newborn might need to be monitored in a intensive neonatal units or if it will need cooling therapy for possible brain injuries or other interventions. The blood gas test results also objectively document your baby’s medical condition at birth. If there is ever any debate about whether your baby received enough oxygen during delivery, these tests will act as an undeniable form of proof.
Cranial Ultrasound: Check for Bleeding
When doctors suspect that your newborn might be suffering from brain injuries due to oxygen deprivation, they will usually first check for it with cranial ultrasounds. It uses sound waves as it passes through the softest area of your baby’s skull (its fontanelle) so it is a non-invasive test and can easily be done right next to your bed in intensive care if necessary.
The ultrasound scans for bleeding in and around the brain, swelling and fluid build up. Intraventricular (bleeding) is rated from 1 to 4 with doctors assuming that 1 and 2 levels will resolve on their own without causing any negative consequences but 3 and 4 levels present much higher risks for your newborn in terms of potential future challenges.
Doctors will also look for periventricular leukomalacia which is when tissue around the fluid filled areas in the brain starts dying and ultimately causing cerebral palsy in one leg more than the other (affecting legs more than arms), although this damage does not usually show at birth.
Here is what parents might not know: Ultrasound does not show everything. There are less obvious injuries that ultrasounds do not catch so doctors sometimes recommend other imaging tests if babies seem to have injuries not detected by an ultrasound.
MRI Scans: More Detailed Testing
Magnetic resonance imaging scans produce incredibly detailed images of structures in the brain but they also require your newborn to lie still as they are being tested otherwise they get thrown around by the magnetic fields so these scans usually only occur after babies are around three days old to one week old.
Unlike ultrasounds which only show injuries, MRI scans show exact locations of injuries. Different events during the delivery process cause different types of damage and injuries to babies’ brains which show the severity of each injury based on its patterns.
Injury patterns that affect the thalamus and basal ganglia (the deep brain structures) indicate severe acute oxygen deprivation at birth while damage done to the watershed areas (the areas between the structures supplied by major blood vessels) show chronic deprivation over time during labor.
The timing of these scans also matter as different types of injuries show up over different periods of time after birth. The most commonly seen patterns usually show up between two days and one week after birth so doctors usually schedule these scans to occur around day three or day seven after birth.
For families wondering whether birth interventions may have caused an injury, MRI scans can provide crucial evidence that helps determine what happened during delivery. If you are considering legal advice, a Birth Injury Lawyer can work with medical experts who review these scan results alongside the documented timeline of events during labor and delivery to assess whether the standard of care was appropriate and whether you may have grounds for a claim.
EEG Monitoring: Patterns of Brain Activity
Electroencephalogram scans check the levels of brain activity in a newborn by testing the electrical waves in baby’s brains. It basically measures the brain’s activity using electrodes placed on a baby’s head. In newborns that have had difficult deliveries, these electrodes can also be used to measure seizures in newborns, known as amplitude integrated EEG (aEEG) monitoring.
Newborns show different signs when they are having seizures as compared to adults so aEEG monitoring can help people assess seizure activity rather than "seeing" a seizure like most people know them to look like. Newborns tend to show different movements during seizures and parents may have already noticed that symptoms do not necessarily look the same to the untrained eye.
Instead of dramatic movements, newborns often look like they are lip smacking or blinking repetitively during seizures. They also have periods during seizures where they look frozen or unresponsive instead of acting like "normal" people during seizure episodes.
When interpreting results from the scan, doctors look for patterns that are normal, moderately abnormal or severely abnormal. A severely abnormal pattern in newborns under one week after birth means that there are serious worries around recorded injuries (or brain deaths), while normal patterns indicate that they are recovering as expected.
After brain injuries that were caused by deprivation of oxygen at birth, seizures normally happen within one to twenty four hours after the injuries occurred; if your newborn has had seizures, however, other factors like frequency, duration and response to treatment record provide assistance to doctors in determining the extent of the damage that was recorded.
Multiple uncontrolled seizures might indicate greater damage that has been done than a single seizure that quickly responds to medical assistance so doctors carefully take this into account when patients present for assistance with treatment.
Cooling Therapy Criteria
If doctors suspect that a baby has been deprived of oxygen at birth to such an extent that it is likely causing damage, they may recommend therapeutic hypothermia (or cooling therapy). Cooling therapy needs to occur within six hours after birth for it to be effective so doctors don’t waste time organizing these assessments and delivering them.
To qualify for cooling therapy, babies need to meet certain criteria including signs of moderate dysfunction in babies such as abnormal muscle tone, reflexes, etc., record signs of acidosis in blood gas tests, and being re evaluated ten minutes after birth (when they are still struggling without help) can also assist in the testing process.
Not every baby that has difficulties or issues during delivery qualify for cooling therapy though so knowing whether your baby did (and if it was administered on time) can be important later if there are queries over whether appropriate care was given after the delivery.
What If You Get Conflicting Test Results
Sometimes test results may return all "good", yet you notice something is still not right with your baby or vice versa: The tests may raise some concerns that do not seem present when you look at your healthy looking bundle of joy. This sort of discrepancy can leave you irritated.
The tests take snapshots of limited bits of information over limited time periods. There is usually still room for things to develop over time, so it might be a good idea to take note of things that still need "normalizing" over time after a traumatic experience like a delivery.
In the meantime though, if you ever notice something not looking quite right with your newborn, do not hesitate to still push to get answers. Parents often know when their babies are changing, even if the medical team does not catch those changes during their quick assessments so do not hesitate to ask for further assistance if needed.
Summary
All these assessments essentially have two outcomes: determining immediate assistance needing monitoring requirements for both short term and long term needs while also identifying objective determinations that may become vital later if issues arise questioning what care was given at birth.
In the short term, doctors will use test results to determine what care each newborn will need in order to stabilize them while also laying some foundation stones to attend additional therapy sessions if necessary later on. These records also become part of your baby’s permanent medical history, which can be reviewed later if concerns develop about whether the care during delivery met the expected standards. Some families find it helpful to keep copies of these test results and reports, particularly if there are questions about the decisions made during labor or if developmental concerns emerge as their child grows.
If you are a family pondering whether birth interventions may have caused an injury, then being aware of these tests will ensure that your newborn receives all possible therapy interventions he or she might need in order to pass through this transitional period successfully. Most babies that need these tests will still turn out just fine.
