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What Is the Apgar Score?
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What Is the Apgar Score?
The Apgar score is a test given to newborns soon after birth. This test checks a baby's heart rate, muscle tone, and other signs to see if extra medical care or emergency care is needed.
The test is usually given twice: once at 1 minute after birth, and again at 5 minutes after birth. Sometimes, if there are concerns about the baby's condition, the test may be given again.
What Does "Apgar" Mean?
Apgar stands for "Appearance, Pulse, Grimace, Activity, and Respiration."
In the test, five things are used 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.
Apgar Scoring
| Apgar Sign | 2 | 1 | 0 |
|---|---|---|---|
| Appearance (skin color) | Normal color all over (hands and feet are pink) | Normal color (but hands and feet are bluish) | Bluish-gray or pale all over |
| Pulse (heart rate) | Normal (above 100 beats per minute) | Below 100 beats per minute | Absent (no pulse) |
| Grimace ("reflex irritability") | Pulls away, sneezes, coughs, or cries with stimulation | Facial movement only (grimace) with stimulation | Absent (no response to stimulation) |
| Activity (muscle tone) | Active, spontaneous movement | Arms and legs flexed with little movement | No movement, "floppy" tone |
| Respiration (breathing rate and effort) | Normal rate and effort, good cry | Slow or irregular breathing, weak cry | Absent (no breathing) |
What Does My Baby's Score Mean?
A baby who scores a 7 or above on the test is considered in good health.
A lower score does not mean that your baby is unhealthy. It means that your baby may need some immediate medical care, such as suctioning of the airways or oxygen to help him or her breathe better. Perfectly healthy babies sometimes have a lower-than-usual score, especially in the first few minutes after birth.
A slightly low score (especially at 1 minute) is common, especially in babies born:
- after a high-risk pregnancy
- through a C-section
- after a complicated labor and delivery
- prematurely
At 5 minutes after birth, the test is given again. If a baby's score was low at first and hasn't improved, or there are other concerns, the doctors and nurses will continue any necessary medical care. The baby will be monitored closely.
What if My Baby Has a Low Score?
Many babies with low scores are perfectly healthy and do just fine after adjusting to life outside the womb.
If your doctor or midwife is concerned about your baby's score, he or she will let you know and will explain how your baby is doing, what might be causing problems (if any), and what care is being given.
What Else Do I Need to Know?
This test was not designed to predict a baby's long-term health, behavior, intelligence, personality, or outcome. It was designed to help health care providers tell a newborn's overall physical condition so that they could quickly decide whether the baby needed immediate medical care.
With time to adjust to the new environment and with any necessary medical care, most babies do very well. So rather than focusing on a number, just enjoy your new baby!
Note: All information is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor.
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What Is the Apgar Score? (for Parents)
What Is the Apgar Score?
The Apgar score is a test given to newborns soon after birth.
This test checks a baby's heart rate, muscle tone, and other signs to see if extra medical care or emergency care is needed.
Babies usually get the test twice: 1 minute after birth, and again 5 minutes after they're born. If there are concerns, a baby may get the test again.
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.
| Apgar Sign | 2 | 1 | 0 |
|---|---|---|---|
| Appearance (skin color) | Normal color all over (hands and feet are pink) | Normal color (but hands and feet are bluish) | Bluish-gray or pale all over |
| Pulse (heart rate) | Normal (above 100 beats per minute) | Below 100 beats per minute | Absent (no pulse) |
| Grimace ("reflex irritability") | Pulls away, sneezes, coughs, or cries with stimulation | Facial movement only (grimace) with stimulation | Absent (no response to stimulation) |
| Activity (muscle tone) | Active, spontaneous movement | Arms and legs flexed with little movement | No movement, "floppy" tone |
| Respiration (breathing rate and effort) | Normal rate and effort, good cry | Slow or irregular breathing, weak cry | Absent (no breathing) |
What Does My Baby's Score Mean?
A baby who scores a 7 or above on the test is considered in good health.
A lower score does not mean that your baby is unhealthy. It means that your baby may need some immediate medical care, such as suctioning of the airways or oxygen to help him or her breathe better. Perfectly healthy babies sometimes have a lower-than-usual score, especially in the first few minutes after birth.
A slightly low score (especially at 1 minute) is common, especially in babies born:
- after a high-risk pregnancy
- through a C-section
- after a complicated labor and delivery
- early
At 5 minutes after birth, babies get the test again. If a baby's score was low at first and isn't better, or there are other concerns, the doctors and nurses will continue any needed medical care. They'll watch the baby closely.
What if My Baby Has a Low Score?
Many babies with low scores are healthy and do just fine after getting used to life outside the womb.
If your doctor or midwife is concerned about your baby's score, they'll let you know and will explain how your baby is doing, what might be causing problems (if any), and what care is being given.
What Else Should I Know?
This test helps health care providers tell a newborn's overall physical condition so they can quickly decide if a baby needs medical care right away. It isn't meant to predict a baby's long-term health, behavior, intelligence, personality, or outcome.
With time to adjust to their new environment and with any needed medical care, most babies do very well.
Reviewed by: Mary L. Gavin, MD
Date reviewed: February 2018
Apgar score - articles from specialists of the clinic "Mother and Child"
first evaluation of the baby
As soon as the child is born, doctors immediately assess his condition and physical development. But not only weight and height are measured for the baby, there are other characteristics by which one can judge how healthy the child is. To do this, use a special scale proposed by the anesthesiologist Virginia Apgar and named after her.
why is it needed
The Apgar score is used to determine which children need more attention.
According to this scale, the health status of each newborn is assessed on five indicators: heart rate, respiration, muscle tone, reflexes and skin color of the baby.
The Apgar score, whether it be high or low, is not a diagnosis. This is a signal for the doctor about what measures are now needed or, conversely, the child does not need. Depending on the results of the assessment, an additional examination may be prescribed: blood tests, urine tests, a study for intrauterine infections, ultrasound, neurosonography. And after that, it is decided what to do next - to observe or treat the child. nine0005
how to test
During examination, each symptom (heart rate, respiration, muscle tone, reflexes, and skin color) is given 0, 1, or 2 points. A score of 2 points in the delivery room is considered the highest and means that the sign is pronounced, 1 point - weakly expressed, 0 points - the sign is absent. The child is evaluated on the Apgar scale at the 1st and 5th minutes of life, so there are always two scores, for example, 8/9 points or 9/10 points.
Children rarely score the maximum 10 points in the first minute of life, and usually the first score is always lower than the second. But the second assessment can just be equal to 10 points. nine0005
evaluation criteria
| 0 points | 1 point | 2 points | |
| Pulse | Missing nine0032 | Less than 100 bpm | Over 100 bpm |
| Breathing | Missing | Slow, irregular | Good, cry |
| nine0002 Muscle tone | Weak | Bends arms and legs | Actively moving |
| Reflexes | Missing | Weakly expressed nine0032 | Called |
| Skin color | Blue, pale | Normal but bluish arms and legs | Normal throughout the body |
counting points
Children who score between 7 and 10 are considered to be in good condition and usually require only routine care.
Those who score between 4 and 6 are in fair condition and may only need some resuscitation. Immediate life-saving assistance is needed for those who score below 4.
| Points | Result |
| 10–7 | Optimal, norm |
| 5-6 | Minor health problems |
| 3-4 | Average deviations in health status |
| 0–2 | Severe deviations in health |
let's be objective
In general, the Apgar score, although it is set according to objective criteria, still does not give an absolutely accurate prediction of the child's health in the future.
It cannot be unequivocally said that a newborn who was given a 9or 10 Apgar scores, healthier than someone who got only 7 points. This only means that in the first case the baby breathes normally, he has pink skin and mucous membranes, he screams loudly enough, he has well-defined reflexes. And in the second case, one or two signs are less pronounced: for example, in the first minute the skin of the extremities is bluish, not pink, because the circulatory system takes about 5 minutes to get it working, or a healthy newborn loses points because he screams quietly in the first minutes life. nine0005
what is important
As already mentioned, the first Apgar score is always lower than the second. In most newborns, the condition 1 minute after birth is estimated at 7-8 points on the Apgar scale, and after 5 minutes - at 8-10 points. And this suggests that the child was born in a satisfactory (normal) condition. If the Apgar score at the 1st minute is low, then the positive dynamics by the 5th minute will be important.
If the points increase by 2 or more by the 5th minute, then most likely the prognosis for health will be favorable. If, 5 minutes after birth, the Apgar score does not exceed 6 points, it will be necessary to conduct intensive therapy or continue resuscitation. So the main task of the Apgar scale is a quick assessment of whether a child needs medical help and how much. nine0005
Whatever the Apgar score, the development of a child largely depends on love, care and upbringing in the family. So parental attention will always help the baby achieve the highest marks in life!
The maximum score of 10 in the first minute of life is rare for children, and usually the first score is always lower than the second. But the second score can just be equal to 10 points
With a low Apgar score at the 1st minute of a baby’s life, positive dynamics is extremely important - an increase of 2 or more points by the 5th minute of life
Most newborns have an Apgar score of 7–8 1 minute after birth and 8–10 Apgar scores 5 minutes later
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Apgar score: what do the scores mean at the birth of a child? nine0001
A baby receives his very first grades not at school, but at the maternity hospital, immediately after birth.
These are Apgar scores.
To learn more about the assessment system itself and find out what it is for, we turned to the doctor of medical sciences, professor, deputy chief physician for neonatology, Batman Yuri Anastasovich at the Leleka maternity hospital
Purpose of creating this assessment method
Scale Apgar was invented in 1952 by midwife Virginia Apgar to quickly assess the condition of the baby after childbirth and determine the need and extent of resuscitation. Since then, there have been many attempts to improve or somehow modify this newborn assessment system. But all the methods for determining the state of the baby, one way or another, were reduced to the original system. nine0005
How and by whom the score is given
The Apgar score includes 5 features:
- Heart rate;
- Breathing;
- Skin colour;
- Muscle tone;
- Reflexes.
Each of these criteria can be scored with 0, 1 or 2 points.
Thus, the maximum score for all 5 features is 10 points. The minimum score, respectively, is 0 points. Unfortunately, this is a bad result for the child. nine0303 The Apgar score is performed by the neonatologist present at the birth.
When is the assessment done?
It is carried out twice: at the end of the first minute of the child's life and at the fifth minute. Many experts of world importance suggest to improve this system and, in case of low scores after the first two measurements, continue the evaluation every 5 minutes until the child's condition is normal. But basically only the first two estimates for 5 minutes of a newborn's life are taken into account. nine0005
Of great importance is the positive dynamics in the assessment of the condition. This is when the assessment results change from lower to higher. A negative trend has a bad prognostic sign. Also more significant for predictions is the second Apgar score, that is, the score at the fifth minute of life.
The child received low scores. Why did this happen?
Normal grades are considered to be within 7-10 points. A baby that has received such marks does not require intensive assistance and can be with its mother from the first minutes of life. nine0005
Lower scores indicate that the child has experienced hypoxia and asphyxia. Apgar scores less than 3 indicate severe perinatal asphyxia, i.e. about the lack of oxygen during childbirth.
The reasons for the birth of children with a low Apgar score are varied. This is both hypoxia transferred by the fetus during pregnancy, and a consequence of many diseases on the part of the mother, fetus or fetoplacental complex.
It is believed that 99% of all causes of a child's severe condition at birth lie in the antenatal or intranatal periods, i.e. during pregnancy and childbirth. Many of them can be diagnosed even in utero and foresee and prevent possible problems in the baby. Therefore, mothers should not neglect examinations during pregnancy.
nine0005
Newborn has low grades – what are the doctors doing?
Children with Apgar scores less than 7-6 require resuscitation. An important role is played by timely second-to-second assistance. This may be the use of oxygen with a mask or tracheal intubation, the introduction of drugs to improve cardiac activity and other medical measures aimed at improving the child's condition.
Features of home care for children with low scores
There are criteria for discharge of newborns. If the child is not healthy, he remains within the limits of the hospital or is transferred to other medical institutions. When the child's condition allows you to go home, he is discharged with recommendations for further medical care.
A low Apgar score is a definite reason for further observation by a pediatrician, neurologist, ophthalmologist and other specialists
What else do you need to know about the Apgar score?
The Apgar score is not responsible for the future viability of the child.
