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Do you know that we as humans are already fighting for ourselves ever since we are brought to this world? It is human blood to survive and live despite any condition or environment we have been in. Those who were born with low Apgar scores would know how fortunate they can be to be able to be alive up till now. You can see how worrying it can be for those conducting childbirth when they find a low Apgar score. In this DoctorOnCall’s article, we will learn about Apgar score.
Apgar score describes the condition of the newborn immediately after birth. It is a tool used to assess the transition of the baby from inside of the womb into the environment we all lived in. Dr. Virginia Apgar, an anesthesiologist at Columbia University, developed the Apgar score in the year of 1952. This explains the name why it is known as Apgar score.
Apgar score has since become a universal standardised tool during childbirth. Healthcare professionals in general will use this scoring when conducting delivery. It is worth noting that Apgar score does not predict individual mortality or adverse neurologic outcome. This is because most infants, even those with very low 1-minute scores, will have normal scores by 5 minutes. However, based on studies, Apgar score less than 5 at 5 minutes and 10 minutes indicates increased risk for cerebral palsy and abnormality correlates to the risk of cerebral palsy. A low Apgar score does not mean an infant will definitely develop cerebral palsy. Although, lower scores over time increases the risk for poor neurologic outcomes.
Apgar score is used to check newborn babies at 1 minute and 5 minutes after birth. Apgar score is a simple assessment used by healthcare professionals to understand general conditions based on observation in the first moments of life. Apgar score often is used to know if a baby needs extra immediate medical care. There are 5 parts of Apgar scoring:
- Skin colour/ oxygenation
- Heart rate
- Reflexes and responsiveness
- Muscle tone
- Breathing
A score of 0, 1 or 2 is assigned to each of the 5 parts:
- Skin colour/ oxygenation – 2 points = pink body, 1 point = pink body but blue extremities (hands and legs), 0 point = complete pale blue body
- Heart rate – 2 points = heartbeat equal to or more than 100 beats/min, 1 point = heartbeat less than 100 beats/min, 0 point = absent of heartbeat
- Reflexes and responsiveness- 2 points = cry, cough or sneeze, 1 point= grimace or feeble cry when stimulated, 0 point = silence or no response to stimulation
- Muscle tone – 2 points = good flexion/ action motion, 1 point = some flexion, 0 point = none or limp
- Breathing effort – 2 points= regular breathing or strong cry, 1 point= irregular, weak, slow breathing or gasping, 0 point= absent of breathing
The maximum score is 10. Scores ranging from 7-10 are considered normal. Apgar scores of 7-10 usually only require post-delivery care. If the 5-minute Apgar score is abnormal which means lower than 7, appropriate measures should be taken. Apgar score should be assigned every 5 minutes until the infant is stabilised. Apgar score below 4 means a newborn in poor condition and in need of immediate medical attention. Apgar score is recommended to be used continuously at 5-minute intervals up to 20 minutes. Apgar score that remains at 0 after 10 minutes may indicate termination of resuscitation efforts as very few infants survive with good neurologic outcomes if no heart rate has been detected for over 10 minutes.
Knowing how Agar score works not only gives information on the baby’s condition for the first few minutes of life, but also be a guide for healthcare professionals should there be the need for more interventions. In general, the lower the score, the more intervention is needed. There are many interventions that are used to improve the Apgar score, such as providing oxygen via the positive pressure ventilation (PPV), airway suctioning using bulb suction, keeping the baby warm, chest compression, physical stimulation and medication or fluid. Certain intervention given will depend on the part affected within the Apgar score.
One thing is certain, most babies with low Apgar scores require oxygen and physical stimulation. Low Apgar score can be caused by fluid in the airway, difficult birth and Following Caesarean section. Apgar scores with a score of 5 or lower often require healthcare professionals to run cord blood gas analysis. This is done by taking the blood from the clamped section of the umbilical cord. Cord blood gas analysis provides information on the oxygen state either it is lowered during delivery and helps to determine if there is known brain damage to the baby such as hypoxic-ischemic encephalopathy.
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It can be concluded that Apgar score is a tool used to assess the newborn. It is a score that is known by all healthcare professionals when delivering a baby. Apgar score does not directly signify indication of potential neurological disease but persistent low Apgar score may be a risk for the adverse outcome to the baby’s neurological system.
