APGAR Scores

We received a letter in the mail this week with a detailed evaluation from the neurologist we saw on Monday. The letter was the first time we've learned about Brady's Apgar scores after his birth. The letter also caused us to reflect on how far Brady has come in these past four months.

An Apgar score rates a baby's appearance, pulse, responsiveness, muscle activity, and breathing with a number from 0 to 2 (2 being the strongest rating). The numbers are then totaled out of a maximum of ten.
Here's how each is used to assess a baby's condition at birth:
Activity (muscle tone)
0 Limp; no movement
1 Some flexion of arms and legs
2 Active motion
Pulse (heart rate)
0 No heart rate
1 Fewer than 100 beats per minute
2 At least 100 beats per minute
Grimace (reflex response)
0 No response to airways being suctioned
1 Grimace during suctioning
2 Grimace and pull away, cough, or sneeze during suctioning
Appearance (color)
0 The baby's whole body is completely bluish-gray or pale
1 Good color in body with bluish hands or feet
2 Good color all over
Respiration (breathing)
0 Not breathing
1 Weak cry; may sound like whimpering, slow or irregular breathing
2 Good, strong cry; normal rate and effort of breathing
The neurologist's letter described these numbers from Brady's chart:
"His Apgars were 0 at 1 minute, 2 at 5 minutes, 4 at 10 minutes and 7 at 20 minutes".

This means that Brady showed absolutely no signs of life at one minute of age. Since they don't break down the scores by category, we would need to guess where he earned those points as time went on. While they were working on Brady, the anesthesiologist came over and told us that Brady was "starting to pink up a bit". I would guess that Brady probably had a trace heartbeat and some color at 5 minutes old giving him those two points. By 10 minutes old he might have moved a little and started breathing a little on his own (with help of ventilator). By 20 minutes old he was still very sick and struggling to survive.

It's haunting to read the Apgar scores and think about those 20 minutes. I'll never forget seeing Brady come out limp. I'll never forget that silence. I'll never forget the look on the doctor's face when the nurse called for the first Code Blue.

Ali kept asking me what was going on and I couldn't answer her. She couldn't see anything because of the sheets in front of her face. She started to struggle and try to free her arms that were strapped down. I looked at the anesthesiologist, he nodded at me, and he gave her some medicine to knock her out for a few minutes.

The anesthesiologist was the first one to give us some hope. He said Brady was getting some color and was going to be fine. It's amazing how your life flashes before your eyes when you go through a moment like that.

The neurologist's letter also talked about Brady's long road to health while he was in the hospital:
"He required positive pressure ventilation, chest compressions and intubation after delivery. He was intubated for a total of five days before being extubated. His neonatal course was complicated by hypotension (low blood pressure) requiring dopamine and dobutamine, thrombocytopenia (platelets in blood), disseminated intravascular coagulation (blood clotting), transaminitis (liver), hypoglycemia (low blood sugar), hyperglycemia (high blood sugar), meconium in lungs, and neonatal seizure. He also required a gastrojejunostomy tube before being discharged to home on April 7, 2012".

It's hard to believe, but the doctors and nurses said Brady was much healthier when he arrived at Amplatz than they expected. Everyone kept talking about how sick Brady was those first few days. Looking back on it now, we didn't understand how hard he was struggling to survive. Almost all of his organs were out of whack.

For six weeks we watched Brady grow stronger until he was healthy enough to come home. His feeding tube is a daily reminder that he's still a work in progress.

The neurologist's letter also described our biggest concerns moving forward:
"An MRI scan was obtained which did reveal a parenchymal hemorrhagic infarction. The areas infected included the left occipital lobe adjacent to the occipital horn in the left lateral ventricle (1.2 cm x 1.2 cm) and a second hypodense area noted in the periventricular white matter on the right corona radiata (5mm in diameter). He had focal brain injuries as well as a global injury that is indicated by the increased tone in his arms and legs".

We know that Brady's brain is not normal. The "dark spots" on his brain were caused by the lack of blood and oxygen during his birth and a possible seizure during his transport to Amplatz. There are still so many unknowns about how those brain injuries will affect our son in the future.

The neurologist's letter also provides us with a great amount of hope:
"Brady was a very bright, alert, young baby who was cooing and smiling throughout the visit. He would raise his hands up and down and flex his legs in excitement. He was able to track me as I moved around the room. No abnormal movement was noted. He showed all normal reflexes for his age".

We're so proud of our miracle baby. We're also so thankful for all of the prayers and words of encouragement. Thanks for everything!

With love,

Tyler, Ali, Ava, Casey and Brady

P.S. We've added a couple of pictures from Brady's four month photo shoot. Click on "see all photos" under the Super Brady picture to see them.