The Apgar scale is a system for assessing the physical condition of newborns in the first minutes of life. It was developed in 1952 by Dr. Virginia Apgar, an American anesthesiologist and pediatrician, and has since been widely used in maternity wards to quickly assess the health of newborns.
Why is the Apgar score of a newborn important?
The Apgar score is an important tool in medical practice and is used for several purposes in the context of neonatal assessment. Here are the main goals and meaning of the Apgar score:
- assessment of the newborn’s condition. The main purpose of the Apgar scale is to assess the physical condition of the newborn in the first minutes of life. It allows doctors to quickly determine how well the baby has adapted to the intrauterine environment and the past birth;
- determination of medical emergency. The Apgar score helps doctors and nursing staff quickly determine whether a newborn needs additional medical care. The results of the scale can help in making decisions about emergency medical interventions;
- adaptation monitoring. The Apgar score monitors how your newborn is adapting to a new life outside the womb. Assessment on this scale can be carried out several times during the first minutes after birth, which allows medical personnel to observe the dynamics of adaptation;
- timely intervention. If the Apgar score shows low scores, this may indicate the need for immediate medical intervention. Health care personnel can take appropriate steps to support and stabilize the child’s condition;
- informing parents. The results of the Apgar scale can be presented to parents as primary information about the condition and well-being of their child after birth. This may help parents better understand the initial situation and the medical interventions that are taking place.
The Apgar score is not a definitive assessment of a child’s health and does not predict future outcomes. It serves as a quick and convenient way to assess the initial condition of the newborn and a guide for further medical actions.
When is the Apgar score performed?
The Apgar score is performed for newborns usually in the first minutes and after 5 minutes after birth. In some cases, depending on the circumstances, the assessment may be completed at a later point in time. Here’s how the Apgar score usually works:
- First assessment (in the first minute after birth). After the birth of a newborn, medical personnel usually assess his condition immediately in the first minute of life. This first assessment helps determine how well the baby has adapted to the intrauterine environment.
- Second assessment (after 5 minutes after birth). After the first assessment in the first minute, a second Apgar assessment is performed 5 minutes after birth. This allows medical staff to monitor the dynamics of the newborn’s adaptation.
If a newborn has a low Apgar score (usually less than 7 out of 10) in the first 5 minutes after birth, this may indicate the need for medical interventions, additional monitoring or care to support his condition.
However, it is worth noting that the Apgar score is not limited to only the first and fifth minutes after birth. In some cases, nursing staff may decide to perform additional assessments as needed to continue monitoring the newborn’s condition.
What indicators does the Apgar scale include?
The Apgar score evaluates five key indicators of a newborn’s physical condition. Apgar scores:
| Index | Grade | Characteristic |
| Activity | 2 | Active movement |
| 1 | Some activity or weak response | |
| 0 | Absence of activity | |
| Pulse | 2 | Pulse over 100 beats per minute |
| 1 | Pulse 100 beats per minute or less | |
| 0 | Absence of heart rate | |
| Reaction to stimuli | 2 | Energetic response |
| 1 | Weak response | |
| 0 | Absence of response | |
| Muscle tone | 2 | Good muscle tone |
| 1 | Some hypotonia | |
| 0 | Hypotonia | |
| Color of the skin | 2 | Pink skin |
| 1 | Pale or bluish skin | |
| 0 | Gray or purplish skin |
After assessing each of these five indicators, the points are added up, and the total Apgar score can range from 0 to 10 points. The higher the score, the better the physical condition of the newborn. This scale provides a quick and convenient assessment of the child’s initial condition and helps health care providers determine whether additional medical interventions or monitoring are needed for the child.
What Apgar score is considered normal?
On the Apgar scale, the indicator that is considered normal is usually 7 points or higher out of 10 possible. However, it is important to understand that the Apgar score always depends on the specific circumstances and context. This means that sometimes even a child with slight abnormalities in the initial Apgar score can adapt normally and become healthy after some time.
When a newborn has a high Apgar score (8-10), this usually indicates good adaptation and physical condition. If a child has a decreased score (less than 7), this may indicate potential problems and the health care team may decide to take additional measures to support the child’s health.
However, the Apgar score is not intended to predict a child’s long-term health outcomes. This is just a tool for quickly assessing the initial condition of the newborn and determining the need for additional medical measures. After the Apgar score, doctors continue to monitor the newborn’s condition and health and may perform additional tests and treatments as needed.
Reasons for low Apgar scores
A low Apgar score can be due to various factors and reasons. It is important to understand that the Apgar scale evaluates the physical condition of a newborn in the first minutes of life, and a low score does not always indicate serious problems. However, it may indicate potential problems that require attention and additional medical measures. Below are some of the possible reasons for a low Apgar score:
- consequences of cesarean section or difficult childbirth. Prolonged or difficult labor or cesarean section may affect Apgar scores;
- lack of oxygen. Lack of oxygen (hypoxia) during labor can lead to decreased activity, muscle tone, and responsiveness to stimuli in the newborn;
- premature birth. Newborns born prematurely often have low Apgar scores due to immaturity of organs and systems;
- infections. Infections transmitted from mother to child, or infections that may occur after birth, can have a negative impact on the condition of the newborn;
- congenital anomalies. Some congenital abnormalities or medical conditions may affect the Apgar score, especially if they are associated with decreased activity, muscle tone, or response to stimuli.
In the case of twins or more, one of the fetuses may have a lower Apgar score due to competition for resources and oxygen inside the uterus. However, many newborns who score low initially can adapt successfully and become healthy with the right medical support and care.