Apgar Score
CLICK HERE ::: https://urlca.com/2tD3KE
Apgar 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.
A score of 7, 8, or 9 is normal and is a sign that the newborn is in good health. A score of 10 is very unusual, since almost all newborns lose 1 point for blue hands and feet, which is normal for after birth.
An evaluation of the newborn's condition is done immediately after delivery and again at five minutes, to determine the APGAR scores. If some cyanosis (bluish skin) is present, the APGAR scores are lower and oxygen may be administered. The oxygen can often be merely blown by the newborn's face, through the mask in front of the infant.
The newborn is commonly assessed with the APGAR score, a quick test performed at 1 and 5 minutes after birth to determine the physical condition of the newborn. The five categories assessed are heart rate, respiratory effort, muscle tone, reflex irritability, and color. Each of these categories is scored 0, 1, or 2, depending on the observed condition of the newborn.
ABSTRACT: 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. The Apgar score alone cannot be considered to be evidence of or a consequence of asphyxia, does not predict individual neonatal mortality or neurologic outcome, and should not be used for that purpose. An Apgar score assigned during a resuscitation is not equivalent to a score assigned to a spontaneously breathing infant. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists encourage use of an expanded Apgar score reporting form that accounts for concurrent resuscitative interventions.
In 1952, Dr. Virginia Apgar devised a scoring system that was a rapid method of assessing the clinical status of the newborn infant at 1 minute of age and the need for prompt intervention to establish breathing 1. A second report evaluating a larger number of patients was published in 1958 2. This scoring system provided a standardized assessment for infants after delivery. The Apgar score comprises five components: 1) color, 2) heart rate, 3) reflexes, 4) muscle tone, and 5) respiration, each of which is given a score of 0, 1, or 2. Thus, the Apgar score quantitates clinical signs of neonatal depression such as cyanosis or pallor, bradycardia, depressed reflex response to stimulation, hypotonia, and apnea or gasping respirations. The score is reported at 1 minute and 5 minutes after birth for all infants, and at 5-minute intervals thereafter until 20 minutes for infants with a score less than 7 3. 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; however, it has been inappropriately used to predict individual adverse neurologic outcome. The purpose of this statement is to place the Apgar score in its proper perspective. This statement revises the 2006 College Committee Opinion and AAP Policy Statement to include updated guidance from Neonatal Encephalopathy and Neurologic Outcome, Second Edition, along with new guidance on neonatal resuscitation.
The 5-minute Apgar score, and particularly a change in the score between 1 minute and 5 minutes, is a useful index of the response to resuscitation. If the Apgar score is less than 7 at 5 minutes, the Neonatal Resuscitation Program guidelines state that the assessment should be repeated every 5 minutes for up to 20 minutes 3. However, an Apgar score assigned during a resuscitation is not equivalent to a score assigned to a spontaneously breathing infant 10. There is no accepted standard for reporting an Apgar score in infants undergoing resuscitation after birth because many of the elements contributing to the score are altered by resuscitation. The concept of an assisted score that accounts for resuscitative interventions has been suggested, but the predictive reliability has not been studied. In order to correctly describe such infants and provide accurate documentation and data collection, an expanded Apgar score report form is encouraged Figure 1. This expanded Apgar score also may prove to be useful in the setting of delayed cord clamping, where the time of birth (complete delivery of the infant), the time of cord clamping, and the time of initiation of resuscitation all can be recorded in the comments box.
Monitoring of low Apgar scores from a delivery service can be useful. Individual case reviews can identify needs for focused educational programs and improvement in systems of perinatal care. Analyzing trends allows for the assessment of the effect of quality improvement interventions.
It is inappropriate to use the Apgar score alone to establish the diagnosis of asphyxia. The term asphyxia, which describes a process of varying severity and duration rather than an end point, should not be applied to birth events unless specific evidence of markedly impaired intrapartum or immediate postnatal gas exchange can be can be documented.
When a newborn has an Apgar score of 5 or less at 5 minutes, umbilical artery blood gas from a clamped section of umbilical cord should be obtained. Submitting the placenta for pathologic examination may be valuable.
Perinatal health care professionals should be consistent in assigning an Apgar score during resuscitation; therefore, the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (the College) encourage use of an expanded Apgar score reporting form that accounts for concurrent resuscitative interventions.
Fig. 1 Expanded Apgar score form. Record the score in the appropriate place at specific time intervals. The additional resuscitative measures (if appropriate) are recorded at the same time that the score is reported using a check mark in the appropriate box. Use the comment box to list other factors including maternal medications and/or the response to resuscitation between the recorded times of scoring. Abbreviations: ETT, endotracheal tube; PPV/NCPAP, positive-pressure ventilation/nasal continuous positive airway pressure.
If your baby's Apgar scores are very low, a mask may be placed over her face to pump oxygen directly into her lungs. If she's not breathing on her own within a few minutes, a tube can be placed into her windpipe, and fluids and medications may be administered through one of the blood vessels in her umbilical cord to strengthen her heartbeat. If her Apgar scores are still low after these treatments, she will be taken to the special-care nursery for more intensive medical attention.
The Apgar score is a quick way for doctors to evaluate the health of all newborns at 1 and 5 minutes after birth and in response to resuscitation.[1] It was originally developed in 1952 by an anesthesiologist at Columbia University, Virginia Apgar, to address the need for a standardized way to evaluate infants shortly after birth.[2]
Today, the categories developed by Apgar used to assess the health of a newborn remain largely the same as in 1952, though the way they are implemented and used has evolved over the years.[3] The score is determined through the evaluation of the newborn in five criteria: activity (tone), pulse, grimace, appearance, and respiration. For each criterion, newborns can receive a score from 0 to 2.[1][3][4] The list of criteria is a backronym of Apgar's surname.
Apgar originally thought up the criteria as way to address the lack of a standardized way to assess the need for assistive breathing procedures for newborns. In 1952, after some refinement of her initial system, Apgar presented the Apgar score at a joint meeting between the International Anesthesia Research Society (IARS) and the International College of Anesthetist, and it was then published in Anesthesia and Analgesia in 1953.[2]
In 1955, efforts to establish a scientific basis to the score increased. Alongside Duncan Holaday and Stanley James,[2] Apgar published a research paper using the scores of 15,348 infants to establish the association between a low Apgar score (0-2) and laboratory findings characteristics of asphyxia.[5]
As previously mentioned, in its infancy the Apgar score was developed to be used on newborns at 1 minute after birth. However, today the Apgar score is not utilized as a way to determine the need for newborn resuscitation because supportive measures must be implemented prior to 1 minute after birth.[4]
Various members of the healthcare team, including midwives, nurses, or physicians, may be involved in the Apgar scoring of a neonate.[3] The test is generally done at one and five minutes after birth and may be repeated later if the score is and remains low. Scores of seven and above are generally normal; four to six, fairly low; and three and below are generally regarded as critically low and cause for immediate resuscitative efforts.[6]
A low score on the one-minute mark may show that the neonate requires medical attention,[7] but does not necessarily indicate a long-term problem, particularly if the score improves at the five-minute mark. A constellation of factors may contribute to a low Apgar score value.[8] An Apgar score that remains below three at five minutes and later times, such as 10, 15, or 30 minutes, does not provide supporting evidence for a specific illness but can sometimes be among the first indicators of neonatal encephalopathy.[8][6][9] However, the Apgar test's purpose is to determine quickly whether or not a newborn needs immediate medical care. It is not designed to predict long-term health issues.[10] 781b155fdc