Overview of APGAR Score
The Apgar score is a simple and quick method to check a newborn baby’s health immediately after birth and also after any resuscitation (emergency treatment). It’s a standard method approved by leading institutions like the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics. This method was initially developed in 1952 by Dr. Virginia Apgar at Columbia University to determine if newborns need medical attention to help them breathe a minute after being born. But new rules by the Neonatal Resuscitation Program do not use Apgar scores for the initial decision of whether to start interventions. Instead, any required resuscitation should commence even before the 1-minute Apgar score is determined.
The Apgar score consists of five elements: skin color, heart rate, reflexes, muscle tone, and breathing. Each of these elements scores between 0 and 2. Through this, doctors can understand if the newborn has any significant issues such as a slow heart rate, low muscle tone, or difficulty breathing. The score is noted twice, at 1 minute and 5 minutes after birth for all babies. If the score is less than or equal to 7 at the 5-minute mark, or if the baby needed emergency treatment, doctors continue recording the score at 5-minute intervals to closely monitor progress. A score between 7 and 10 is considered pretty normal.
However, it’s important to remember that Apgar Scores might differ based on factors like how far along the pregnancy was, the baby’s birth weight, if the mother was on medication, and whether the baby was born with any anomalies (abnormal conditions). Each factor in the score is somewhat subjective so different doctors might rate them slightly differently. The score provides a snapshot of the baby’s physiological status at a specific point in time. Therefore, the Apgar score should not be considered as the sole proof of a condition called asphyxia (a lack of oxygen at birth), nor should it be the only determinant in outcome studies. The immediate treatment of a newborn baby should always be prioritized over calculating a clinical score.
Why do People Need APGAR Score
The Apgar test is a routine check conducted on all babies at the time of birth, both at 1 minute and 5 minutes after they are born. It’s a quick measure that looks at a newborn’s overall health status and helps doctors decide if the baby needs additional medical or emergency care. This Apgar test result becomes part of the baby’s health record.
Doctors advise to pay extra attention to babies who get a score less than 7 in the Apgar test. In fact, the American College of Obstetricians and Gynecologists along with the American Academy of Pediatrics recommend that a more detailed Apgar score be recorded. Recording this extended Apgar score can help doctors to see how well the baby is responding to any medical care or revived efforts they are providing.
When a Person Should Avoid APGAR Score
Apgar scoring is a test that doctors use to assess a newborn’s health. There are no noted reasons why it shouldn’t be used. However, there are certain situations where the score might not show the true health condition of the baby. For instance, if a baby needs to be made motionless with medication, or if they need to have surgery right after birth, the score might not accurately reflect their health condition.
Equipment used for APGAR Score
Auscultation is a method doctors use to study the sounds of your body, mainly your heart and lungs. It’s generally done using a stethoscope. Nevertheless, for more precise details, an electrocardiogram (a test that checks how your heart is working by measuring its electrical activity) is the best option. You don’t need to bring anything extra for this.
They may also use a pulse oximeter, a small device they clip to your finger to measure how much oxygen your blood is carrying. It’s ideal to have a radiant warmer and an electrocardiogram close by when delivering a baby. The warmer is used to prevent hypothermia (a condition where the body loses heat faster than it can produce it) in newborns, and the electrocardiogram monitors the baby’s heart rate if resuscitation (emergency medical procedures to revive someone whose heart has stopped or is not breathing) is needed. If these are not available, warm blankets and a stethoscope can be used as alternatives.
Who is needed to perform APGAR Score?
The 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. Depending on the scenario, various medical experts may be responsible for determining the Apgar score. These professionals could include:
A neonatologist, a type of doctor who is trained specifically to handle the most complex and high-risk situations for newborn babies.
A pediatrician, your child’s doctor who understands children’s health and any special concerns they might have.
A nurse practitioner, a nurse who has extra training and can handle many of the same health care tasks that doctors do.
A family physician, your regular doctor who watches over your general health.
A midwife, a trained health professional who helps women during labor, delivery, and after the birth of their babies.
A nurse, who is a healthcare professional that takes care of patients in hospitals, clinics, and other healthcare facilities. They play an important role in your healthcare team.
A respiratory therapist, a specialist healthcare practitioner trained in pulmonary (related to lungs and breathing) medicine in order to work therapeutically with people suffering from pulmonary disease.
They all play a vital role in ensuring your baby’s wellbeing during those vital first minutes after birth.
How is APGAR Score performed
The Apgar score is a simple method doctors use to quickly assess the physical condition of a newborn baby immediately after birth. It’s made up of five different categories, each of which gets scored as 0, 1, or 2. These scores are added together to give a total Apgar score, which is recorded at 1 and 5 minutes after birth.
Here’s how they interpret the scores:
– A score of 7 to 10 means the baby is in good health.
– A score of 4 to 6 is somewhat concerning.
– A score of 0 to 3 is worrisome, especially for full-term or late preterm babies.
If the baby’s score is less than 7 at 5 minutes, the doctor will continue to check them every 5 minutes for up to 20 minutes. It’s important to know that scores taken while a baby is being revived are not the same as scores for a baby who is not being revived, because the revival process can change some parts of the score.
Here’s how each category is judged:
1. Breathing effort:
– If the baby isn’t breathing, they score a 0.
– If their breathing is slow, irregular, weak or they’re gasping, they score a 1.
– If the baby is crying loudly, they score a 2.
2. Heart Rate:
– If there is no heartbeat, they score a 0.
– If the heartbeat is less than 100 beats per minute (bpm), they score a 1.
– If the heartbeat is more than 100 bpm, they score a 2.
3. Muscle Tone:
– If the baby is completely relaxed and floppy, they score a 0.
– If the baby shows some strength and flexibility, they score a 1.
– If the baby is very active and muscles counteract extension, they score a 2.
4. Reaction to Stimulation (also called Reflex Irritability):
– If the baby does not respond to stimulation, they score a 0.
– If the baby makes a face in response to stimulation, they score a 1.
– If the baby cries, coughs, or sneezes in response to stimulation, they score a 2.
5. Color:
– If the baby is pale or blue, they score a 0.
– If the baby is pink but their hands and feet are blue (which is common), they score a 1.
– If the baby is completely pink, they score a 2.
This is a simple way for doctors to asses how the baby is doing in the first few minutes of life and judge whether they need any immediate care.
What Else Should I Know About APGAR Score?
The Apgar score is a quick test that your doctor or midwife performs on your baby. The test is usually done right after birth and again a few minutes later. The Apgar score helps doctors and nurses determine if a newborn baby needs extra medical help, like help with breathing.
But the Apgar score isn’t perfect. A low score doesn’t always mean that the baby experienced a lack of oxygen (or asphyxia), or that they had other serious problems during the birth. While some babies with a low Apgar score at 1 minute may face some problems down the road, the change in scores from 1 to 5 minutes and the scores at 5 and 10 minutes are more often linked with a baby’s future health.
A low Apgar score at the 5-minute mark is linked with a higher chance of serious problems, like death, or conditions such as cerebral palsy which affects the baby’s brain and muscles. However, not every baby with a low score develops these issues. The lower the score stays over time, the higher the chance of having some health issues. However, it’s a significant tool to track the baby’s health over time. If a baby’s score is less than 5 at 5 minutes, it’s usual for the doctors to take a sample of blood from the baby’s umbilical cord for further tests.
Getting a score of 0 at 10 minutes might seem scary, but remember, it doesn’t always mean that the baby will have long-term health problems. In fact, many of these babies end up surviving and grow up without any different developmental disabilities. Therefore, experts don’t guide doctors to stop trying to save the baby if they score 0 at 10 minutes.
