The Apgar score provides information about the baby’s health condition shortly after birth. It is performed using a standardized method based on a scoring scheme. The test results are relevant only to the current situation and do not predict the newborn’s future development.
What is the Apgar score?
The determination of the Apgar score is based on a standardized testing method designed to assess the baby’s health shortly after birth. Determination of the Apgar score is based on a standardized test method designed to assess the baby’s health status shortly after birth. The test was developed in 1952 by Virginia Apgar, an American anesthesiologist. In this method, important bodily functions of the newborn are examined one minute and then again five and ten minutes after birth. After the introduction of the Apgar score, infant mortality caused by complications at birth dropped significantly. Dangers are detected immediately and can be averted by resuscitation measures if necessary. 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 the case of premature births. Due to the physical immaturity of a premature baby, many bodily functions are naturally restricted here, making the Apgar score unsuitable as a standardized test method in this case.
Function, effect, and goals
The Apgar score is intended to immediately detect any complications that may arise during or after the birth of the baby so that action can be taken quickly. For example, previously undiagnosed prenatal damage, such as brain hemorrhage or oxygen deprivation, often led to chronic health limitations, disability, or even death. Virginia Apgar laid out in her book that birth is the most dangerous stage of life. Many dangers lurk here, but they can be quickly detected with a simple testing method. In the Apgar Score, which she developed, she defined five criteria that are mandatory to be examined. These criteria include respiratory effort, heart rate, muscle tone, skin color and reflex triggering. Up to two points can be assigned for each characteristic. Thus, two points means the features are fully developed. One point means limited development of the corresponding trait, while zero points means it is completely absent. For respiratory effort, two points are awarded for regular breathing, one point for irregular breathing, and zero points for no breathing. A heart rate above 100/min means two points, with below 100/min giving only one point. Of course, if the heartbeat is absent, no point can be awarded. Full expression of reflexes is expressed by vigorous crying. If they are imperfectly expressed, only grimaces are noted. If the infant does not react at all, no points can be awarded. Muscle tone is greatest when the extremities are actively moving, somewhat less when they are slightly flexed, and absent at all when the muscles are flaccid. If the skin color is rosy all over the body, it means awarding two points. However, if the extremities are blue, only one point can be awarded. If the skin color is pale or blue, this indicates severe respiratory disorders. A point award is then excluded. Achieving eight to ten points is considered a very good result. The baby is then in good to excellent condition. In most cases, this result is achieved. The deduction of one or two points may be due to the efforts made during the birth process. Generally, however, this is not a problem because the baby usually recovers quickly. However, if the score is between five and seven, the baby is considered to be at risk. If necessary, the newborn must then be ventilated and the airway suctioned. However, this is not always necessary. Here, too, the baby usually recovers quickly with a little support. There is an acute danger to life if the score is below five. In this case, the infant needs warmth, light and oxygen. He is placed in an incubator for care. If the score is low, the Apgar score is repeated until it returns to normal.
Risks, side effects, and hazards
However, there are limitations to the use of the Apgar score. For example, accompanying circumstances at birth must also be included in the assessment.Medications, infections, congenital anomalies, birth trauma or blood loss affect the score. The use of the scoring system is not suitable for premature infants 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 may occur due to lack of oxygen. However, this depends on how long the complication lasted. In many cases, no permanent damage occurs. However, the cause of the hypoxia should be determined. Also, the Apgar score is not sufficient for the diagnosis of acute asphyxia (suffocation). After complications have been overcome, the current score also cannot provide information about the baby’s condition. Thus, the scores after resuscitation differ significantly from a spontaneously breathing infant. The results of resuscitation measures are therefore taken into account in a so-called extended Apgar score. Here, the infant is monitored for 20 minutes. Here, the scaling has been changed, whereby up to ten points can be achieved per characteristic. Thus, in the extended Apgar score, a score between seven and ten after five to ten minutes is considered very good.
