Apgar score is a quick test performed on a baby at 1 and 5 minutes after birth. The 1-minute score determines how well the baby tolerated the birthing process. The 5-minute score tells the health care provider how well the baby is doing outside the mother’s womb. The Apgar score provides an accepted and convenient method for reporting the status of the newborn infant immediately after birth and the response to resuscitation if needed. This scoring system (named after its creator, Virginia Apgar) helps the physician estimate your baby’s general condition at birth.
In rare cases, the test will be done 10 minutes after birth.
What Does It Check?
The Apgar score measures five things to check a baby’s health. Each is scored on a scale of 0 to 2, with 2 being the best score:
• Appearance (skin color)
• Pulse (heart rate)
• Grimace response (reflexes)
• Activity (muscle tone)
• Respiration (breathing rate and effort)
Doctors, midwives, or nurses add up these five factors for the Apgar score. Scores are between 10 and 0. Ten is the highest score possible, but few babies get it. That’s because most babies’ hands and feet remain blue until they have warmed up.
▪︎ Appearance (skin color)
• Score 2 – Normal color all over (hands and feet are pink)
• Score 1 – Normal color (but hands and feet are bluish)
• Score 0 – Bluish-gray or pale all over
▪︎ Pulse (heart rate)
• Score 2 – Normal (above 100 beats per minute)
• Score 1 – Below 100 beats per minute
• Score 0 – Absent(no pulse)
▪︎ Grimace (“reflex irritability”)
• Score 2 – Pulls away, sneezes, coughs, or cries with stimulation
• Score 1 – Facial movement only (grimace) with stimulation
• Score 0 – Absent (no response to stimulation)
▪︎ Activity (muscle tone)
• Score 2 – Active, spontaneous movement
• Score 1 – Arms and legs flexed with little movement
• Score 0 – No movement, “floppy” tone
▪︎ Respiration (breathing rate and effort)
• Score 2 – Normal rate and effort, good cry
• Score 1 – Slow or irregular breathing, weak cry
• Score 0 – Absent (no breathing)
How is the Apgar Test Scored?
Each characteristic is given an individual score; two points for each of the five categories if all is completely well; then all scores are totaled. For example, let’s say your baby has a heart rate of more than 100, cries lustily, moves actively, grimaces and coughs in response to the syringe, but is blue; her one minute Apgar score would be 8—two points off because she is blue and not pink. Most newborn infants have Apgar scores greater than 7.Because their hands and feet remain blue until they are quite warm, few score a perfect 10.
• If your baby’s Apgar scores are between 5 and 7 at one minute, she may have experienced some problems during birth that lowered the oxygen in her blood. In this case, the hospital nursing staff probably will dry her vigorously with a towel while oxygen is held under her nose. This should start her breathing deeply and improve her oxygen supply so that her five-minute Apgar scores total between 8 and 10.
• A small percentage of newborns have Apgar scores of less than 5. For example, babies born prematurely or delivered by emergency C-section are more likely to have low scores than infants with normal births. These scores may reflect difficulties the baby experienced during labor or problems with her heart or respiratory system.
What Abnormal Results Mean?
Any score lower than 7 is a sign that the baby needs medical attention. The lower the score, the more help the baby needs to adjust outside the mother’s womb.
Most of the time a low Apgar score is caused by:
• Difficult birth
• Fluid in the baby’s airway
A baby with a low Apgar score may need:
• Oxygen and clearing out the airway to help with breathing
• Physical stimulation to get the heart beating at a healthy rate
Most of the time, a low score at 1 minute is near-normal by 5 minutes.
A lower Apgar score does not mean a child will have serious or long-term health problems. The Apgar score is not designed to predict the future health of the child.
Limitations of Apgar Score –
It is important to recognize the limitations of the Apgar score.
• The Apgar score is an expression of the infant’s physiologic condition at one point in time, which includes subjective components.
• There are numerous factors that can influence the Apgar score, including maternal sedation or anesthesia, congenital malformations, gestational age, trauma, and interobserver variability. In addition, the biochemical disturbance must be significant before the score is affected.
• Elements of the score such as tone, color, and reflex irritability can be subjective, and partially depend on the physiologic maturity of the infant. The score also may be affected by variations in normal transition. For example, lower initial oxygen saturations in the first few minutes need not prompt immediate supplemental oxygen administration; the Neonatal Resuscitation Program targets for oxygen saturation are 60–65% at 1 minute and 80–85% at 5 minutes.
• The healthy preterm infant with no evidence of asphyxia may receive a low score only because of immaturity.
• The incidence of low Apgar scores is inversely related to birth weight, and a low score cannot predict morbidity or mortality for any individual infant.
• As previously stated, it also is inappropriate to use an Apgar score alone to diagnose asphyxia.
Conclusions on Apgar score –
While the Apgar score has value in helping medical providers understand how a baby is doing immediately after birth, the score doesn’t usually have any bearing on how healthy a baby is long term.
Also, because a person is assigning the number, the Apgar score is subjective. One person could score a baby a “7” while another could score the baby a “6.” This is why the Apgar score is just one of several assessments used to evaluate a newborn’s general condition.
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