Virginia Apgar developed a scoring system for a newborn baby's first "tests", or Apgars in 1952. These tests are performed on the baby at 1 and 5 minutes after birth, and they measure the infant's heart rate, respiration, muscle tone, reflex responses, and coloring. Each characteristic is given a high score of two points if everything is good and all is well, a medium score of one point if there is a little concern, and a low score of zero if there is a problem. These tests are continued every five minutes for the next twenty minutes if the total score is less than seven. Very few infants score a perfect 10, and this is because most newborns have blue hands and feet until they are warmed up. An infant that scores a zero for 10 minutes or longer has to be evaluated to see if further resuscitation should continue. Very few babies survive with normal neurological functions at this point. An Apgar score of 7-10 is considered reassuring, a score of 4-6 is considered to be moderately abnormal, and a score of 0-3 is considered to be low.
The Chart Reads As This:
Breathing Effort
If the baby is not breathing, the respiratory score is 0.
If respirations are slow and irregular, weak, or gasping, the respiratory score is 1.
If the baby is crying vigorously, the respiratory score is 2.
Heart rate
The heart rate is evaluated with a stethoscope or an electrocardiogram and is the most critical part of the score in determining the need for resuscitation.
If there is no heartbeat, the heart rate score is 0.
If the heart rate is <100 bpm, the heart rate score is 1.
If the heart rate is >100 bpm, the heart rate score is 2.
Muscle tone
In inactive baby with loose and floppy muscle tone, the score for muscle tone is 0.
In babies demonstrating some tone and flexion, the score for muscle tone is 1.
In babies in active motion with a flexed muscle tone that resists extension, the muscle tone score is 2.
Grimace response or reflex irritability in response to stimulation
In a baby with no response to stimulation, the reflex irritability response score is 0.
A baby grimacing in response to stimulation has a reflex irritability response score of 1.
In a baby who cries, coughs, or sneezes on stimulation, the reflex irritability response is 2.
Color
Most infants will score 1 for color even at the 5-minute, as peripheral cyanosis is common among normal infants. Color can also be misleading in non-white infants.
If the baby is pale or blue, the score for color is 0.
If the baby is pink, but the extremities are blue, the score for color is 1.
If the baby is entirely pink, the score for color is 2.
Now that we understand the scoring system, we have to think about the factors that can influence the Apgar Score in the moments after birth. To begin with, a mother who has been sedated or put on anesthesia, congenital malformations or anomalies, birth trauma, drug use, or gestational age can all affect the baby's score. Also, some of the characteristics that are being scored can be subjective, and sometimes the maturity of the infant can affect the score in a negative way at first, but might not indicate a real problem overall. The Apgar Score should never be the only diagnosis for serious problems like asphyxia. Overall, the Apgar Score can be helpful in determining the condition of a newborn infant right after it is born, and can indicate risks and abnormalities that could lead to cerebral palsy or even death. The Apgar Score is one of many different tools that doctors and midwives can use to help document the baby's wellbeing.
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