Doctors evaluate a newborn’s health as soon as possible to make sure everything is well. The APGAR scale, which aids in assessing vital signs like breathing, muscular tone, and heart rate, is one of the instruments they employ.
After birth, the APGAR score is provided twice: once at one minute and once at five minutes. These scores offer important insights into the baby’s level of adjustment to life outside the womb.
Knowing the APGAR score can make parents feel more knowledgeable during those crucial early stages. Understanding the significance of each score can bring comfort and understanding during an exhilarating and occasionally bewildering period.
APGAR Criteria | Score 0 | Score 1 | Score 2 |
Appearance (Skin Color) | Blue or pale all over | Blue at extremities | Completely pink |
Pulse (Heart Rate) | Absent | Below 100 beats/min | 100 beats/min or more |
Grimace (Reflex Response) | No response | Grimaces | Coughs, pulls away, or sneezes |
Activity (Muscle Tone) | Limp | Some flexion | Active motion |
Respiration (Breathing) | Absent | Slow or irregular | Good, crying |
- History
- Indicators
- Decoding
- Examination algorithm
- What do the following points mean
- Prognosis
- Video on the topic
- How the condition of a newborn is assessed? What do the APGAR scores mean?
- ASSESSMENT ON THE APGAR SCALE | Newborn Health Assessment System in the Maternity Hospital
- APGAR Scale for Newborns. Assessment by the Apgar Scale.
- Apgar Scale for Newborns – Points at Birth, Table
- Assessment of Newborns by the Apgar Scale.
- Apgar Scale (Points) for Assessing a Newborn – meduniver.com
History
The scale is named for Virginia Apgar, an American anesthesiologist who developed the assessment of all newborns over 60 years ago. The ability to rapidly evaluate the health of newborns was the driving force behind the creation of this kind of survey. The technique proved to be incredibly easy to use and convenient, which made it possible for it to be used in obstetrics. Thousands of physicians use the Apgar scale nowadays, all over the world.
Indicators
The following criteria are assessed using the Apgar scale:
- Baby"s skin color (Appearance). This indicator is very informative, simple and allows you to identify circulatory disorders. If the baby"s body is completely pale or there is cyanosis over its entire surface, 0 points are given. Pale coloring is often detected in hemolytic disease. With a pink body color, but cyanosis of the arms and legs, the child is given 1 point. If the baby"s skin is completely pink, this is 2 points. Since most babies have red skin, and cyanosis of the extremities is very often detected, this parameter most often underestimates the total Apgar score (children are rarely given 2 points).
- Baby"s heart rate (Pulse). The normal pulse rate for newborns is 120-140 beats per minute. In the absence of heartbeats, the score will be 0 points. If the pulse is less than 100 beats per minute, the baby is given 1 point. If the heart rate of a newborn is above 100 beats, 2 are given points.
- Presence of reflexes and response to stimulation (Grimace). To determine them, mucus is sucked out of the baby"s nose and his reaction is observed or other reflexes are checked. The absence of reflex movements is estimated at 0 points, and for weak reflexes, represented by a grimace and movement, the baby is given 1 point. If the baby actively moves in response to irritation, screams loudly, sneezes, coughs, this is estimated at 2 points.
- Status of muscle tone (Activity). Normally, a newborn has increased muscle tone, and the baby actively and chaotically moves its legs and arms. If there is no muscle tone, and the baby"s limbs hang down, the parameter is estimated at 0 points. With weak tone and slight flexion of the limbs, the child is given 1 point, and activity and the presence of pronounced tone gives the right to give 2 points for this feature.
- Breathing and crying of the child (Respiration). Age norm of the frequency of respiratory movements for a newborn baby is 40-45 per minute. If the baby screams loudly, this helps him breathe more intensely and is a sign of good adaptive capabilities of the toddler. If there is no breathing, the child gets 0 points. If breathing is irregular and shallow, and the cry is weak, this is 1 point. With normal breathing and a loud cry, the child will have a score of 2 points. If the child has asphyxia, this is the parameter that lowers the Apgar score.
Decoding
As mentioned previously, the physician assigns a 3-point rating to each indicator: The scores are as follows: 0 for no sign, 1 for weak expression, and 2 for normalcy and clear sign expression. The total score is the sum of all the points that are awarded.
The score for newborns can be understood by looking at the following table:
One, two, or zero points
This is an important sign. A newborn with this score requires immediate resuscitation. He will require ongoing specialized monitoring and thorough examination.
Three or four points
With average deviations from the norm, this indicator is deemed satisfactory. It is frequently found in premature infants. Given this assessment, doctors must monitor the baby closely.
Five or six points
This indicator, with its small departures from the average, is satisfactory. Doctors should give a child with such an assessment more attention.
Points 7, 8, or 9
This is the ideal number for a newborn. It makes doctors and new parents happy.
Ten points
Due to our mentality, domestic doctors do not use this best indicator (maximum score), which a healthy baby frequently receives when they travel abroad. In order not to "jinx it" or give the impression that most babies these days do not have perfect conditions, doctors are reluctant to state the maximum.
Examination algorithm
The infant’s condition is evaluated twice: the first time in the first minute of life and again in the fifth minute. The total points are expressed as a dash (just like in fractions). For instance, 7/8 indicates that the baby had 7 points at birth and 8 points five minutes later. Indicator values of 0/4 indicate 0 points during childbirth and 4 points in the fifth minute following delivery. In the tenth minute, if needed, the third examination is conducted.
Eight points is the typical APgar score for healthy infants. Such babies show small decreases (1 point) in two indicators, such as bluish limbs and pulses below 100, and norms (2 points) in three parameters. Seldom are the maximum 10 points displayed.
The second or third rating is typically higher than the first, which is referred to as a positive dynamic. This results from the newborn’s adjustment to its new surroundings. The skin turns pink, the breathing returns to normal, the protective reflex kicks in, and other reactions become more noticeable. The pulse also quickened. There is a drop, though, as seen in 9/8 or 8/7, for instance. In this instance, there is an improvement in medical tan monitoring.
Doctors and nurses use the APGAR scale, a quick and easy test, to evaluate a newborn’s health shortly after birth. The test generates an overall score based on five critical factors: appearance, respiration, grimace, pulse, and activity. This score is used to assess whether a baby requires further monitoring or immediate medical attention. This article describes each score and how the condition of a newborn is assessed using it.
What do the following points mean
Let’s examine some instances of Apgar assessments and their interpretations:
8/9, 9/9, or 9/10
The infant feels fantastic and is in excellent health. It is not necessary to closely monitor obstetric staff following childbirth.
8/8
The child feels well, is in normal condition, and adjusts to life outside the mother’s womb quickly.
5/7, 6/7, or 7/8
The average health status of crumbs. After giving birth, the infant is initially weaker but quickly adjusts to its new surroundings. The infant doesn’t require the medical staff to monitor it closely.
7/7
The small one is in acceptable shape. He doesn’t require extra obstetric staff supervision.
5/5 or 6/6
Although the baby’s condition is satisfactory, close observation is needed during the postpartum phase.
4/5 or 5/6
Although the child’s state is below average, there is a tendency for it to get better. Throughout the first week of life, the infant needs to be closely observed.
3/4 or 4/4
The infant’s health is not good. Obstetricians must assist with it, and the initial weeks following delivery require closer monitoring. These evaluations typically call for a third test in the tenth minute of life.
2/3 or 3/3
The infant’s condition is critical. Most of the time, it needs to be revived immediately.
Either 1/2 or 2/2
The baby’s life is in danger, so resuscitation procedures are necessary.
0.1, 0/2, or 1/1
The infant’s life is in jeopardy. Both a thorough examination of the infant and immediate resuscitation are required.
Prognosis
It should be mentioned to parents when explaining the Apgar scale that the total number of points does not always represent the true health of the infant. Remember that the points are provided by an individual (even if he works in healthcare), based on his personal experience and subjective opinion.
Moreover, such an evaluation cannot be referred to as a diagnosis. For the pediatrician and obstetrician, this is merely an additional technique that allows them to quickly assess the baby’s viability.
Low Apgar scores shouldn’t be further cause for concern, and high scores are nothing to be proud of. This method’s primary objective is to assist medical professionals in giving the baby prompt assistance.
The mother shouldn’t be alarmed if the baby scored 7 or 8, even though there is a significant difference between 4-5 and 8-9 points. A 9/9 score does not imply that the child is more robust or healthier than an 8/8 or 7/7 score. This could indicate that the infant with 9 points cried out more and had more noticeable reflexes, while the infant with 8 points might have had blue skin from a protracted labor.
Only the obstetric staff can use the baby’s Apgar score to determine what precautions to take in the delivery room and postpartum area. All newborns receive a general examination before undergoing additional testing (blood, urine, ultrasound, and other tests), the results of which are used to determine the baby’s treatment plan.
In any event, a newborn who receives an Apgar score of less than five needs far more medical care than one who receives a score of seven or higher. Nonetheless, the infant is moved to the group of kids who don’t need constant medical supervision if, in the first minute, he received 4-5 points and, in the fifth, his condition could be evaluated at 7 or 8.
It should be noted that babies born via cesarean section typically have higher Apgar scores because the natural birth method is more challenging for the baby and frequently results in hypoxia. Consequently, babies born via cesarean section frequently score between 8 and 9.
Twins and triplets with multiple pregnancies typically have low Apgar scores. Premature babies have worse development indicators than babies born on time, and they are typically born earlier.
If a birth injury causes severe spastic tetraparesis, for instance, a low Apgar score is also assigned. These injuries can have a variety of effects, so it’s hard to predict with certainty whether the newborn will be crippled. After receiving low scores, the infant receives the recommended care and assistance.
The APGAR scale offers a rapid, preliminary evaluation of a newborn’s health. It assists medical professionals in determining whether the infant requires emergency care.
A baby is doing well if their score is between 7 and 10, which is typically regarded as normal. A newborn may require more care and observation if their score falls outside of this range.
This easy-to-use yet reliable test is essential to ensuring that newborns receive the best care possible during those crucial initial moments following birth. Parents can rely on medical professionals to use the APGAR scale to ensure their child has the best possible start in life.