Journal of Pediatric Neurology and Medicine

Late Diagnosis of Hypoxic-Ischemic Encephalopathy in a Child with Normal Apgar Scores

Abstract

Tahir Sheikh, Eric Hirsch, Daryl Duran and Ranga Krishna

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.