Of the Apgar score provides information about the baby's health shortly after birth. It is carried out according to a standardized method based on a point scheme. The test results are only relevant for the current situation and do not provide any prognosis for the future development of the newborn.
What is the Apgar Score?
The determination of the Apgar score is based on a standardized test method that is intended to assess the baby's state of health shortly after birth. The test was developed in 1952 by the American anesthetist Virginia Apgar.
With this method, important body functions of the newborn are examined one minute and then five and ten minutes after the birth. After the introduction of the Apgar score, the infant mortality rate from complications at birth decreased significantly. Dangers are recognized immediately and, if necessary, can be averted through resuscitation measures.
The test is based on a point system in which a maximum of 10 points can be achieved. There are limits to the use of the test in premature babies. Due to the physical immaturity of a premature baby, many body functions are naturally restricted, so that the Apgar score is unsuitable as a standardized test method in this case.
Function, effect & goals
With the Apgar score, any complications that may arise during or after the birth of the baby are to be recognized immediately so that action can be taken quickly. For example, previously undiagnosed prenatal damage, such as cerebral haemorrhage or lack of oxygen, often led to chronic health restrictions, disabilities or even death. Virginia Apgar stated in her book that childbirth is the most dangerous phase in life. Many dangers lurk here, but they can be quickly identified with a simple test method.
In the Apgar score she developed, she specified five criteria that must be examined. These criteria include breathing effort, heart rate, muscle tone, skin color and the ability to trigger reflexes. Up to two points can be awarded for each characteristic. The characteristics are fully developed for two points. A point means a limited development of the corresponding feature, while zero points are completely absent. With the breathing effort, two points are awarded for regular, one point for irregular and zero points for no breathing.
A heart rate over 100 / min means two points, whereas below 100 / min only gives one point. If the heartbeat is missing, no point can of course be awarded. The full expression of the reflexes is expressed in vigorous screaming. If they are imperfect, only grimaces can be seen. If the infant does not react at all, no points can be awarded. The muscle tone is greatest when the extremities are actively moving, somewhat smaller when they are slightly flexed and not at all when the muscles are slack. If the skin color is rosy all over the body, this means that two points have been awarded.
However, if the extremities are blue then only one point can be awarded. If the skin is pale or blue, this indicates severe breathing disorders. A point award is then excluded. Achieving eight to ten points is rated as a very good result. The baby is then in good to excellent shape. In most cases this result is achieved. The deduction of one or two points may be due to the effort involved in the labor process. In general, this is not a problem because the baby usually recovers quickly.
However, if the score is between five and seven, the baby is considered at risk. If necessary, the newborn must then be ventilated and the airway suctioned off. However, this is not always necessary. Here, too, the baby usually recovers quickly with a little help. There is an acute danger to life if the score is below five. In this case, the infant needs warmth, light and oxygen. It is placed in an incubator for supply. If the score is low, the Apgar score is repeated until the values have normalized.
Risks, side effects & dangers
However, there are also restrictions on the use of the Apgar score.Concomitant circumstances at birth must also be included in the assessment. Drugs, infections, congenital abnormalities, birth trauma, or blood loss all affect the score. The scoring scheme is not suitable for premature babies because the body is not yet fully developed.
The infant will need to spend some time in the incubator before all functions are fully developed. Neurological complications cannot be predicted using the Apgar score. If the score is below five, cerebral palsy can occur due to lack of oxygen. But that depends on how long the complication lasted. In many cases there is no permanent damage. However, the cause of the hypoxia should be determined. The Apgar score is also insufficient for the diagnosis of acute asphyxia (state of suffocation).
Once complications have been overcome, the current number of points cannot provide any information about the baby's condition. After resuscitation, the values differ significantly from those of a spontaneously breathing infant. The results of resuscitation measures are therefore taken into account in what is known as an extended Apgar score. The child is monitored for 20 minutes. The scaling has been changed here, whereby up to ten points can be achieved per feature. With the extended Apgar score, a value between seven and ten after five to ten minutes is considered very good.
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